{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T01:48:13Z","timestamp":1769305693468,"version":"3.49.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,7]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> Although the spontaneous occurrence of an unruptured vertebral artery (VA) dissection has increasingly been recognized as a relatively common cause of stroke, and the clinical aspects of this lesion have gradually been determined, its natural course remains obscure. The main goal of this study was to clarify the management protocol for this condition by examining serial angiographic changes in patients with unruptured VA dissections.<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> Seventeen patients with unruptured VA dissections, including 13 men and four women, were clinically and angiographically examined between 1993 and 1998. All patients were observed using serial angiography studies. The initial angiography examinations most frequently revealed stenotic lesions (appearance of a pearl-andstring sign or string sign) in eight (47.1%) of 17 cases. In 15 cases (88.2%), changes in the lesions were evident on follow-up angiography studies. Stenotic lesions resulted in occlusion in four cases, normalization in three, and subsequent formation of an aneurysm in one case, which was treated successfully by proximal occlusion of the affected vessel performed using a detachable balloon. Occluded lesions, which were initially observed in three patients, recanalized in two patients and remained unchanged in one patient. Fusiform dilation alone was demonstrated in three patients during the initial angiography session; these lesions became normalized or were unchanged on follow-up studies. Saccular aneurysms were observed in two patients. In one of these cases, proximal ligation of the parent artery was successfully performed because of subsequent aneurysm enlargement. A double lumen, which appeared in one patient with an extradural VA dissection, became occluded. Magnetic resonance T<jats:sub>2<\/jats:sub>-weighted imaging studies revealed infarction corresponding to the posterior circulation in seven cases. During long-term observation in this series, good or excellent recovery was obtained in 14 (87.5%) of 16 patients, and moderate or severe disability in two (12.5%); one patient was lost to follow up after the second angiography study.<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> A follow-up angiography study must be performed during the early stage (within approximately 3 weeks after onset of symptoms) to confirm the formation or enlargement of an aneurysm, because such conditions may be amenable to surgical treatment. Unruptured VA dissection could otherwise be treated and followed conservatively. Although the majority of dissected lesions seem likely to stabilize within a few months, as evidenced on angiography, in some cases a longer observation period is required.<\/jats:p>","DOI":"10.3171\/jns.2000.93.1.0019","type":"journal-article","created":{"date-parts":[[2009,5,13]],"date-time":"2009-05-13T17:27:38Z","timestamp":1242235658000},"page":"19-25","source":"Crossref","is-referenced-by-count":125,"title":["Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings"],"prefix":"10.3171","volume":"93","author":[{"given":"Kazuhiko","family":"Nakagawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajime","family":"Touho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshitaka","family":"Morisako","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiko","family":"Osaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Tatsuzawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruhiko","family":"Nakae","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kei","family":"Owada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuya","family":"Matsuda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Karasawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"No Shinkei Geka","first-page":"443","article-title":"[Vertebral artery dissection without subarachnoid hemorrhage studied by serial angiography.]","volume":"24","author":"Akiyama","year":"1996"},{"key":"b2","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1212\/WNL.38.6.868","article-title":"Dissection of the intracranial vertebral artery.","volume":"38","author":"Caplan","year":"1988"},{"key":"b3","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1136\/jnnp.63.1.46","article-title":"Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis.","volume":"63","author":"De Bray","year":"1997"},{"key":"b4","series-title":"No Shinkei Geka","first-page":"1001","article-title":"[A case of vertebrobasilar dissection which was associated with progressing stroke and successfully treated by intravascular surgery in the acute stage.]","volume":"26","author":"Endoh","year":"1998"},{"key":"b5","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1161\/01.STR.30.5.1083","article-title":"Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection.","volume":"30","author":"Hosoya","year":"1999"},{"key":"b6","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1993","DOI":"10.1161\/01.STR.28.10.1993","article-title":"Magnetic resonance angiography demonstrates vascular healing of carotid and vertebral artery dissections.","volume":"28","author":"Kasner","year":"1997"},{"key":"b7","series-title":"Neurosurgery","first-page":"620","article-title":"Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations.","volume":"34","author":"Kitanaka","year":"1994"},{"key":"b8","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1161\/01.STR.25.3.571","article-title":"Magnetic resonance imaging study of intracranial vertebrobasilar artery dissections.","volume":"25","author":"Kitanaka","year":"1994"},{"key":"b9","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"667","DOI":"10.3171\/jns.1994.80.4.0667","article-title":"Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography.","volume":"80","author":"Kitanaka","year":"1994"},{"key":"b10","series-title":"AJNR","first-page":"1482","article-title":"Preliminary experience using contrast-enhanced MR angiography to assess vertebral artery structure for the follow-up of suspected dissection.","volume":"20","author":"Leclerc","year":"1999"},{"key":"b11","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1148\/radiology.190.1.8259436","article-title":"Carotid and vertebral artery dissections: three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography.","volume":"190","author":"Levy","year":"1994"},{"key":"b12","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1161\/01.STR.24.4.598","article-title":"Recurrent ischemic events in two patients with painless vertebral artery dissection.","volume":"24","author":"McCormick","year":"1993"},{"key":"b13","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1227\/00006123-199505000-00003","article-title":"Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms.","volume":"36","author":"Mizutani","year":"1995"},{"key":"b14","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1212\/WNL.38.6.880","article-title":"Spontaneous dissections of the vertebral arteries.","volume":"38","author":"Mokri","year":"1988"},{"key":"b15","series-title":"J Int Med Res","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1177\/030006059902700208","article-title":"Endovascular embolization of unruptured vertebral dissection using guglielmi electrolytically detachable coils: case report.","volume":"27","author":"Nomura","year":"1999"},{"key":"b16","series-title":"No Socchu No Geka","first-page":"293","article-title":"[Management for dissecting aneurysms of the vertebral artery.]","volume":"22","author":"Onda","year":"1994"},{"key":"b17","series-title":"No Socchu No Geka","first-page":"128","article-title":"[An analysis of intracranial dissecting aneurysms of the vertebrobasilar system: treatment and the longterm outcome of 50 cases.]","volume":"3","author":"Ono","year":"1994"},{"key":"b18","series-title":"No Socchu No Geka","first-page":"167","article-title":"[Management of unruptured intracranial dissecting aneurysms in vertebrobasilar system: analysis of serial changes in angiographic findings and long-term outcome.]","volume":"23","author":"Ono","year":"1995"},{"key":"b19","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/0090-3019(94)90108-2","article-title":"Dissecting aneurysms of the vertebrobasilar system: study of 16 cases.","volume":"41","author":"Pozzati","year":"1994"},{"key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"69","DOI":"10.3171\/jns.1991.75.1.0069","article-title":"Benign arterial dissections of the posterior circulation.","volume":"75","author":"Pozzati","year":"1991"},{"key":"b21","series-title":"J Comput Assist Tomogr","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1097\/00004728-199603000-00004","article-title":"Spontaneous vertebral dissection: clinical, conventional angiographic, CT, and MR findings.","volume":"20","author":"Provenzale","year":"1996"},{"key":"b22","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"964","DOI":"10.3171\/jns.1990.72.6.0964","article-title":"Magnetic resonance demonstration of vertebral artery dissection. Report of two cases.","volume":"72","author":"Quint","year":"1990"},{"key":"b23","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3171\/jns.1990.72.2.0183","article-title":"Dissecting aneurysms of the intracranial vertebral artery.","volume":"72","author":"Yamaura","year":"1990"},{"key":"b24","series-title":"Neurol Med Chir","doi-asserted-by":"publisher","first-page":"343","DOI":"10.2176\/nmc.24.343","article-title":"[Dissecting aneurysm of the vertebro-basilar artery. Case report.]","volume":"24","author":"Yokoyama","year":"1984"},{"key":"b25","series-title":"Surg Neurol","first-page":"407","article-title":"Dissecting intracranial aneurysms.","volume":"8","author":"Yonas","year":"1977"},{"key":"b26","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1161\/01.STR.28.2.370","article-title":"Unruptured intracranial vertebral artery dissection: clinical course and serial radiographic imagings.","volume":"28","author":"Yoshimoto","year":"1997"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/93\/1\/article-p19.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/93\/1\/article-p19.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/93\/1\/article-p19.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T22:38:40Z","timestamp":1679870320000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/93\/1\/article-p19.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,7]]},"references-count":26,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/jns.2000.93.1.0019","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[2000,7]]}}}