Treatment of hemorrhagic intracranial dissections

René Anxionnat, João Ferreira De Melo Neto, Serge Bracard, Jean Christophe Lacour, Catherine Pinelli, Thierry Civit, Luc Picard, Robert Harbaugh, Andreas Gruber, Bernd Richling, Gabriele Schackert, Bernard R. Bendok, L. Nelson Hopkins

Research output: Contribution to journalReview article

69 Citations (Scopus)

Abstract

OBJECTIVE: To analyze the treatment options in hemorrhagic intracranial dissections. METHODS: This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT). RESULTS: EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63%) had a good recovery, six (22%) had a moderate disability, and four (15%) died. CONCLUSION: EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.

Original languageEnglish (US)
Pages (from-to)289-301
Number of pages13
JournalNeurosurgery
Volume53
Issue number2
DOIs
StatePublished - Aug 1 2003

Fingerprint

Dissection
Therapeutics
Balloon Occlusion
Stents
Vertebral Artery
Diagnostic Errors
Rupture
Permeability
Arteries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Anxionnat, R., De Melo Neto, J. F., Bracard, S., Lacour, J. C., Pinelli, C., Civit, T., ... Hopkins, L. N. (2003). Treatment of hemorrhagic intracranial dissections. Neurosurgery, 53(2), 289-301. https://doi.org/10.1227/01.NEU.0000073417.01297.93
Anxionnat, René ; De Melo Neto, João Ferreira ; Bracard, Serge ; Lacour, Jean Christophe ; Pinelli, Catherine ; Civit, Thierry ; Picard, Luc ; Harbaugh, Robert ; Gruber, Andreas ; Richling, Bernd ; Schackert, Gabriele ; Bendok, Bernard R. ; Hopkins, L. Nelson. / Treatment of hemorrhagic intracranial dissections. In: Neurosurgery. 2003 ; Vol. 53, No. 2. pp. 289-301.
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abstract = "OBJECTIVE: To analyze the treatment options in hemorrhagic intracranial dissections. METHODS: This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT). RESULTS: EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63{\%}) had a good recovery, six (22{\%}) had a moderate disability, and four (15{\%}) died. CONCLUSION: EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.",
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Anxionnat, R, De Melo Neto, JF, Bracard, S, Lacour, JC, Pinelli, C, Civit, T, Picard, L, Harbaugh, R, Gruber, A, Richling, B, Schackert, G, Bendok, BR & Hopkins, LN 2003, 'Treatment of hemorrhagic intracranial dissections', Neurosurgery, vol. 53, no. 2, pp. 289-301. https://doi.org/10.1227/01.NEU.0000073417.01297.93

Treatment of hemorrhagic intracranial dissections. / Anxionnat, René; De Melo Neto, João Ferreira; Bracard, Serge; Lacour, Jean Christophe; Pinelli, Catherine; Civit, Thierry; Picard, Luc; Harbaugh, Robert; Gruber, Andreas; Richling, Bernd; Schackert, Gabriele; Bendok, Bernard R.; Hopkins, L. Nelson.

In: Neurosurgery, Vol. 53, No. 2, 01.08.2003, p. 289-301.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Treatment of hemorrhagic intracranial dissections

AU - Anxionnat, René

AU - De Melo Neto, João Ferreira

AU - Bracard, Serge

AU - Lacour, Jean Christophe

AU - Pinelli, Catherine

AU - Civit, Thierry

AU - Picard, Luc

AU - Harbaugh, Robert

AU - Gruber, Andreas

AU - Richling, Bernd

AU - Schackert, Gabriele

AU - Bendok, Bernard R.

AU - Hopkins, L. Nelson

PY - 2003/8/1

Y1 - 2003/8/1

N2 - OBJECTIVE: To analyze the treatment options in hemorrhagic intracranial dissections. METHODS: This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT). RESULTS: EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63%) had a good recovery, six (22%) had a moderate disability, and four (15%) died. CONCLUSION: EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.

AB - OBJECTIVE: To analyze the treatment options in hemorrhagic intracranial dissections. METHODS: This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT). RESULTS: EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63%) had a good recovery, six (22%) had a moderate disability, and four (15%) died. CONCLUSION: EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.

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Anxionnat R, De Melo Neto JF, Bracard S, Lacour JC, Pinelli C, Civit T et al. Treatment of hemorrhagic intracranial dissections. Neurosurgery. 2003 Aug 1;53(2):289-301. https://doi.org/10.1227/01.NEU.0000073417.01297.93