Updates in the Management of Cerebral Infarctions and Subarachnoid Hemorrhage Secondary to Intracranial Arterial Dissection: A Systematic Review

Fawaz Al-Mufti, Naveed Kamal, Nitesh Damodara, Rolla Nuoman, Raghav Gupta, Naif M. Alotaibi, Ahmed Alkanaq, Mohammad El-Ghanem, Irwin A. Keller, Steven Schonfeld, Gaurav Gupta, Sudipta Roychowdhury

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Objective: Intracranial arterial dissection (IAD) is a rare cerebrovascular disease that is likely underdiagnosed because of the inherent difficulty of visualizing the subtle radiographic signs of the pathologic small intracranial arteries. No widespread consensus exists on the treatment of IAD, and thus it is often managed empirically because of the absence of major randomized controlled trials. In this study, we conducted a systematic review to evaluate the management and treatment options for IAD. Methods: We performed a systematic review in accordance with the PRISMA guidelines using the following databases: MEDLINE (PubMed) and Cochrane Library. Included studies were limited to human patients with dissections in intracranial vessels only. Results: A total of 82 studies were included in this systematic review. The most common complications of IAD were cerebral infarction and subarachnoid hemorrhage, and thus, patients with IAD can be subdivided into those presenting with either ischemia or hemorrhage, respectively. Those with ischemia were predominantly managed with antiplatelet therapy, whereas patients presenting with hemorrhage often were amenable to treatment with endovascular techniques. Conclusions: Given these findings, clinicians should prescribe antiplatelet therapy for patients with IAD presenting with ischemia and consider endovascular treatment for those presenting with hemorrhage. However, further investigation is required given the heterogeneity of methods and reporting outcomes in the investigated studies.

Original languageEnglish (US)
Pages (from-to)51-58
Number of pages8
JournalWorld Neurosurgery
Volume121
DOIs
StatePublished - Jan 2019

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Keywords

  • Aneurysm
  • Dissection
  • Hemorrhage
  • Intracranial
  • Ischemia

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