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01-04-2007 | Neuro

Dissection of the V4 segment of the vertebral artery: clinicoradiologic manifestations and endovascular treatment

Authors: Woong Yoon, Jeong Jin Seo, Tae Sun Kim, Huy M. Do, Mahesh V. Jayaraman, Michael P. Marks

Published in: European Radiology | Issue 4/2007

Abstract

Intracranial vertebral artery (VA) dissection has three clinical presentations: ischemia, hemorrhage, and mass effect. Imaging findings of intracranial VA dissections vary according to clinical presentation. Irregular stenosis or occlusion of the VA is the most common finding in patients with posterior fossa infarction, whereas a dissecting aneurysm is the main feature in those with acute subarachnoid hemorrhage. A chronic, giant, dissecting aneurysm can cause mass effect on the brain stem or cranial nerves, as well as distal embolism. Magnetic resonance imaging is useful for detection of intramural hematomas and intimal flaps, both of which are diagnostic of VA dissection. Multidetector computed tomography angiography is increasingly used for diagnosis of VA dissection. Catheter angiography is still beneficial for evaluation of precise endoluminal morphology of the dissection before surgical or endovascular intervention. Endovascular treatment is now considered a major therapeutic option for patients with a ruptured dissecting aneurysm or a chronic dissecting aneurysm. Anticoagulation therapy is currently considered the initial treatment of choice in patients with posterior circulation ischemic symptoms. Endovascular treatment, such as stent-assisted angioplasty or coil occlusion at the dissection site, can be performed in selected patients with posterior fossa ischemic symptoms.

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Title: Dissection of the V4 segment of the vertebral artery: clinicoradiologic manifestations and endovascular treatment
Authors: Woong Yoon
Jeong Jin Seo
Tae Sun Kim
Huy M. Do
Mahesh V. Jayaraman
Michael P. Marks
Publication date: 01-04-2007
Publisher: Springer-Verlag
Published in: European Radiology / Issue 4/2007
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-006-0272-8

At a glance: The STEP trials

Springer Medicine

Dissection of the V4 segment of the vertebral artery: clinicoradiologic manifestations and endovascular treatment

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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