The pathogenesis of spontaneous cervicocephalic arterial dissection is still incompletely understood. The clinical presentation of the arterial dissection depends on the plane where the dissection occurred in the arterial wall. When the outer media or subadventitia is dissected, the intramural hematoma bulges outward to make dissecting aneurysm. When located in the subintima or inner media, the intramural hematoma produces narrowing or occlusion of the vessel lumen. Authors review etiopathogeness, clinical features, diagnosis and management of cerviococephalic arterial dissection.
Aneurysm, Dissecting* ; Brain Ischemia ; Diagnosis ; Hematoma ; Subarachnoid Hemorrhage ; Vertebral Artery*

Aneurysm, Dissecting ; diagnosis ; surgery ; Aortic Aneurysm, Abdominal ; diagnosis ; surgery ; Female ; Humans ; Middle Aged

Diagnosis of spontaneous coronary artery dissection (SCAD) is challenging because of its rarity and uncertain etiology. It frequently occurs in young women during pregnancy and in the postpartum period, and rarely found in elder women with no history of cardiovascular disease or coronary risk factors. In this article we report a case of SCAD in a 75-year-old woman without traditional cardiovascular risk factors who presented with syncope and mild chest discomfort. There were no abnormal electrocardiographic changes and no elevated cardiac enzymes were detected. Computed tomography of brain revealed nothing abnormal. Coronary artery disease was suspected. Coronary angiogram revealed dissection in the middle left circumflex artery. The patient underwent percutaneous transluminal coronary angioplasty and was free of symptoms at 6-month follow-up. Our report suggests that emergency coronary angiography is indicated if syncope caused by coronary artery disease is suspected.
Aged ; Aneurysm, Dissecting ; diagnosis ; diagnostic imaging ; Coronary Aneurysm ; diagnosis ; diagnostic imaging ; Coronary Angiography ; Female ; Humans

OBJECTIVETo explore the differences in the characteristics of acute aortic dissection (AAD) among less and more economically developed countries with various cultures and races.

DATA SOURCESReports from the International Registry of Acute Aortic Dissection (IRAD) and the mainland of China (MC) were collected by searching the PubMed Database and the Chinese Journal Full-text Database from January 2000 to March 2009.

STUDY SELECTIONThose reports from IRAD and MC containing larger numbers of cases and complete patients' information were selected, which focused on concrete issues of diagnosing or managing AAD were excluded if they were not able to reflect the overall characteristics of this condition. And the data from the article containing the largest number patients reported by the same medical center in MC were taken into statistics.

RESULTSAAD patients from MC were significantly younger than IRAD countries and the percentage of male patients in the Chinese group was higher than IRAD countries (80.7% vs. 68.6%, P < 0.001). Patients in MC were less likely to present with typical symptoms and signs except for any focal neurological deficits. Different from the IRAD group, Chinese patients were prone to undergo magnetic resonance imaging (MRI) to make the diagnosis of AAD (45.5% vs. 11.6%, P < 0.001). The in-hospital mortality was similar between 2 groups but only smaller proportion of AAD patients in MC underwent surgical or medical treatment.

CONCLUSIONSThe general characteristics of AAD patients in MC were shown and differences in some clinical variables between MC and IRAD groups still existed.

Adult ; Aged ; Aneurysm, Dissecting ; diagnosis ; Aortic Aneurysm ; diagnosis ; China ; Female ; Humans ; Male ; Middle Aged

Subarachnoid hemorrhage (SAH) from vertebral artery (VA) dissecting aneurysms is rare and potentially fatal. Early rebleeding from ruptured VA dissecting aneurysms excessively reduces favorable outcome rates of the ruptured dissecting aneurysms, so that early diagnosis and treatment are essential for preventing early rebleeding and devastating results. A 52-year-old man was referred to our hospital due to an abruptly developed severe headache and sequential mental change. SAH due to ruptured left VA dissecting aneurysm was noted. We performed early endovascular internal trapping, and successful flow arrest on final angiogram was confirmed. About 6 hours later after internal trapping of the aneurysm, his mentality abruptly deteriorated and rebleeding was confirmed. We present this case of early rebleeding from vertebral dissecting aneurysm after endovascular internal trapping, along with a literature review.
Aneurysm ; Aneurysm, Dissecting* ; Early Diagnosis ; Headache ; Humans ; Middle Aged ; Subarachnoid Hemorrhage ; Vertebral Artery*

Adult ; Aneurysm, Dissecting ; complications ; diagnosis ; Aortic Aneurysm ; complications ; diagnosis ; Diagnostic Errors ; Female ; Humans ; Myocardial Infarction ; complications ; diagnosis

OBJECTIVE: Vertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs. MATERIALS AND METHODS: Between July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture. RESULTS: Clinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either. CONCLUSION: Endovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment.
Aneurysm, Dissecting* ; Angiography, Digital Subtraction ; Diagnosis ; Endovascular Procedures ; Humans ; Prognosis ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery*

Rupture of an intracranial dissecting aneurysm is a rare but dangerous event and are difficult to diagnosis and manage, and carry a high morbidity and mortality. The angiographic features typically showed fusiform dilatation and proximal and/or distal dilatation of the affected artery. Depending of location of dissection, surgical options are;ligation, trapping, or reenforcement of exposed abnormal portion of vessels. The authors report a case of nontraumatic dissecting aneurysm, stroke with subarachnoid hemorrhage(SAH) and the proximal porton of origin of PICA was treated with dlipping of vertebral artery proximal to dissecting aneurysm.
Aneurysm, Dissecting* ; Arteries ; Diagnosis ; Dilatation ; Mortality ; Pica ; Rupture ; Stroke ; Subarachnoid Hemorrhage ; Vertebral Artery*

Aortic dissection accompanying with preeclampsia during pregnancy can be lethal to both the mother and the fetus and carries a high mortality. Of the 2 preeclampsia patients with aortic dissection, one was Type B aortic dissection, occurring in postpartum period. The patient was treated medically and underwent catheter-based stent-graft treatment with fenestration technique. Another patient was Type A acute dissection, occurring in the third trimester. This patient was undiagnosed and both died. Although extremely rare, aortic dissection might be a possibility in preeclampsia pregnant women, the differential diagnosis of chest and/or epigastric pain in preeclampia patient should be thoroughly investigated and treated.
Adult ; Aneurysm, Dissecting ; diagnosis ; etiology ; Female ; Humans ; Pre-Eclampsia ; physiopathology ; Pregnancy ; Pregnancy Complications, Cardiovascular

Endovascular aortic repair is often performed for the treatment of aortic disease because of less invasiveness and fewer complications. Cardiac tamponade is a fatal disease that can lead to death if not treated properly. Cardiac puncture by rigid guide wire used in endovascular aortic repair may cause cardiac tamponade. Rapid diagnosis and treatment are needed when cardiac tamponade occurs. Confirmation of the cardiac tamponade can be accomplished with echocardiography. Continuous echocardiography should be monitor for detection of cardiac complications during endovascular aortic repair.
Aneurysm, Dissecting ; Aortic Diseases ; Cardiac Tamponade ; Diagnosis ; Echocardiography ; Endovascular Procedures ; Punctures ; Rupture