Sikkema, T. (2012) Intracranial artery dissection : A retrospective single center cohort study. thesis, Medicine.
Full text available on request.Abstract
Background and purpose: Intracranial artery dissections (IADs) are of clinical importance, because they can cause a disabling ischemic stroke or a subarachnoid hemorrhage (SAH) in relatively young patients. The aim of this study was to evaluate clinical and radiological features, treatment options, functional outcome and prognostic factors in patients with an IAD. Another aim was to determine differences between anterior and posterior circulation dissections and between patients presenting with and without SAH. Material and methods: In this retrospective cohort study, 68 patients with an IAD, admitted to the University Medical Center Groningen between January 1998 and May 2012, were included. Diagnosis of IAD was based on pre-specified angiographic features, analyzed by two interventional neuroradiologists. Baseline characteristics, symptoms, radiological features, treatment options, functional outcome and prognostic factors were analyzed and stratified for location of the IAD (anterior versus posterior circulation) and clinical presentation (SAH versus non-SAH). Results: There were 41 women and 27 men (mean age 49.9 years). SAH occurred in 42 patients and 26 patients presented without SAH. The vertebral artery was most frequently involved. Anterior circulation dissection occurred in 21 patients and posterior circulation dissection in 47 patients. Patients presenting with SAH or with posterior circulation dissection were older, had higher blood glucose levels, more frequently a history of hypertension and more often an aneurysm distant to a bifurcation site on angiography compared to patients without SAH or with anterior circulation dissection. Preceding symptoms were also different. The most reported symptom was headache. Patients presenting without SAH were predominantly treated with medication, while patients presenting with SAH received most often endovascular treatment. Functional outcome was favorable in 64.7% of all patients. Patients presenting with SAH fared worse compared to patients presenting without SAH. However, overall survival was above 80%. In our series, higher age, a history of hypertension, involvement of the vertebral artery, absence of prior antiplatelet treatment and worse Glasgow Coma Scale (GCS) score on admission were identified as independent predictors of an unfavorable functional outcome. Conclusions: There are several differences between anterior and posterior circulation dissections and between presentation with and without SAH, indicating that they might have a different natural course. Overall survival was above 80%. Unfavorable outcome was independently predicted by higher age, a history of hypertension, involvement of the vertebral artery, absence of prior antiplatelet treatment and worse GCS score on admission.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Luijckx, Dr. G.J. / Dr. M. Uyttenboogaart and Institution: University Medical Center Groningen and Department: Neurology |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:43 |
| Last Modified: | 25 Jun 2020 10:43 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/484 |
Actions (login required)
 |
View Item |