NONSURGICAL TREATMENT OF UNRUPTURED INTRACRANIAL VERTEBRAL ARTERY DISSECTION WITH SERIAL FOLLOW-UP ANGIOGRAPHY

The question of whether unruptured intracranial vertebral artery disse ctions should be treated surgically or nonsurgically still remains unr esolved. In this study, six consecutive patients with intracranial ver tebral artery dissection presenting with brain-stem ischemia without s ubarachnoid hemorrhage (SAH) were treated nonsurgically with control o f blood pressure and bed rest, and five received follow-up review with serial angiography. No further progression of dissection or associate d SAH occurred in any of the cases, and all patients returned to their previous lifestyles. In the serial angiograms in five patients, the f indings continued to change during the first few months after onset. F our cases ultimately showed ''angiographic cure,'' while fusiform aneu rysmal dilatation of the affected vessel persisted in one case. In one patient, arterial dissection was visualized on the second angiogram d espite negative initial angiographic findings. These results indicate that intracranial vertebral artery dissection presenting without SAH c an be treated nonsurgically, with careful angiographic follow-up monit oring. Persistent aneurysmal dilatation as a sequela of arterial disse ction seemed to form a subgroup of fusiform aneurysms of the posterior circulation. These aneurysms may be prone to late bleeding and may re quire surgical treatment.