European Radiology

, Volume 17, Issue 4, pp 983–993 | Cite as

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

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


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.


Vertebral artery Arterial dissection Endovascular therapy 


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Woong Yoon
    • 1
  • Jeong Jin Seo
    • 1
  • Tae Sun Kim
    • 2
  • Huy M. Do
    • 3
  • Mahesh V. Jayaraman
    • 3
  • Michael P. Marks
    • 3
  1. 1.Department of Radiology, Chonnam National University HospitalChonnam National University Medical School501-757Dong-guSouth Korea
  2. 2.Department of Neurosurgery, Chonnam National University HospitalChonnam National University Medical SchoolDong-guSouth Korea
  3. 3.Department of RadiologyStanford University Medical CenterStanfordUSA

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