Haruma Jun, Sugiu Kenji, Ebisudani Yuki, Kimura Ryu, Edaki Hisanori, Yamaoka Yoko, Kawakami Masato, Soutome Yuta, Hiramatsu Masafumi
Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan.
J Neuroendovasc Ther. 2024;18(3):92-102. doi: 10.5797/jnet.ra.2023-0068. Epub 2024 Jan 13.
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.
颅内动脉夹层（IADs）虽不常见，但却是脑梗死和蛛网膜下腔出血（SAH）的重要病因。一些IADs在血管腔重建后可自发愈合，预后良好。与此同时，另一些则可能进展为需要治疗的卒中。IADs在后循环中的发生率高于前循环。前循环夹层更易发展为缺血，而后循环病变更易发展为出血。SAH患者IADs后的死亡率为19% - 83%。此外，无SAH的IADs死亡率为0% - 3%。SAH患者通常接受手术或神经血管内治疗（EVT）以预防再出血。然而，在缺乏随机对照试验数据的情况下，IADs的治疗是经验性的。最近，EVT已出现，并因其侵入性较小且被认为与手术相关的发病率低且疗效良好而被考虑用于IADs。EVT策略可分为解构性（涉及牺牲母动脉）和重建性（通过母血管保持血流）技术。特别是，关于重建技术的报道数量正在增加。然而，尚未建立针对破裂IADs的重建技术。本综述旨在通过文献检索概述采用EVT治疗的后循环IADs。
