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Endovascular Treatment for Intracranial Artery Dissections in Posterior Circulation
Jun Haruma1, Kenji Sugiu1, Yuki Ebisudani1
1Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan.
Insights
Intracranial artery dissections (IADs) in the posterior circulation are common and can cause stroke. Neuroendovascular treatment (EVT) is increasingly used, with reconstructive techniques showing promise for managing these complex cases.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Intracranial artery dissections (IADs) are a significant cause of stroke and hemorrhage.
- Posterior circulation IADs are more common and prone to hemorrhage than anterior circulation IADs.
- Current treatment for IADs lacks randomized controlled trial data, often relying on empirical approaches.
Purpose of the Study:
- To review the current literature on neuroendovascular treatment (EVT) for intracranial artery dissections in the posterior circulation.
- To provide an overview of EVT strategies, including deconstructive and reconstructive techniques.
- To highlight the emerging role and challenges of reconstructive EVT for ruptured posterior circulation IADs.
Main Methods:
- Literature search for studies on EVT in posterior circulation IADs.
- Analysis of EVT strategies, focusing on deconstructive versus reconstructive techniques.
- Review of reported outcomes and efficacy of different EVT approaches.
Main Results:
- EVT is increasingly utilized for IADs due to its minimally invasive nature and efficacy.
- Reconstructive EVT techniques are gaining attention, with a growing number of reports.
- Established reconstructive techniques for ruptured posterior circulation IADs are still lacking.
Conclusions:
- EVT represents a viable treatment option for posterior circulation IADs.
- Reconstructive EVT techniques offer potential for preserving parent vessel flow in IAD management.
- Further research and development of standardized reconstructive techniques are needed for ruptured IADs.
Abstract:
Intracranial artery dissections (IADs), although uncommon, are an important cause of cerebral infarction and subarachnoid hemorrhage (SAH). Some IADs can heal spontaneously after reconstitution of the vessel lumen with excellent prognosis. Meanwhile, others can progress to stroke that requires treatment. The incidence of IAD in the posterior circulation is higher than that in the anterior circulation. Anterior circulation dissections are more likely to develop into ischemia and posterior circulation lesions into hemorrhage. The mortality rate after IAD among patients with SAH is 19%-83%. Further, the mortality rate of IAD without SAH is 0%-3%. Patients with SAH commonly undergo surgery or receive neuroendovascular treatment (EVT) to prevent rebleeding. However, the treatment of IADs is empirical in the absence of data from randomized controlled trials. Recently, EVT has emerged and is considered for IADs because of its less invasiveness and perceived low rates of procedure-related morbidity with good efficacy. EVT strategies can be classified into deconstructive (involving sacrifice of the parent artery) and reconstructive (preserving blood flow via the parent vessel) techniques. In particular, the number of reports on reconstructive techniques is increasing. However, a reconstructive technique for ruptured IADs has not yet been established. This review aimed to provide an overview of IADs in the posterior circulation managed with EVT by performing a literature search.
