Published Online
on May 10, 2007

A more recent version of this article appeared on June 1, 2007

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Submitted on December 5, 2006
Revised on February 9, 2007
Accepted on February 20, 2007

Prognosis and Safety of Anticoagulation in Intracranial Artery Dissections in Adults

Tiina M. Metso MD^*; Antti J. Metso MD, PhD; Johanna Helenius MD, PhD; Elena Haapaniemi MD, PhD; Oili Salonen MD, PhD; Matti Porras MD, PhD; Juha Hernesniemi MD, PhD; Markku Kaste MD, PhD; and Turgut Tatlisumak MD, PhD

From Departments of Neurology (T.M.M., A.J.M., J. Helenius, E.H., M.K., T.T.), Helsinki Medical Imaging Center (M.P., O.S.), and Neurosurgery (J.Hernesniemi), Helsinki University Central Hospital, Helsinki, Finland.

^* To whom correspondence should be addressed. E-mail: antti.metso{at}helsinki.fi.

Background and Purpose--To characterize different forms of intracranial artery dissections (IADs), and to test the assumption that IADs are frequently associated with subarachnoid hemorrhage (SAH) and poor outcome, and that anticoagulant therapy is contraindicated in these patients.

Methods--We studied 81 consecutive non-SAH IAD patients and 22 IAD patients with SAH, diagnosed between 1994 and 2004 and 1998 and 2004, respectively, and treated the former patients immediately with heparin, followed with at least 3 months of warfarin. Outcomes were recorded at 3 months.

Results--Approximately one-third of all cervicocephalic artery dissections were identifiably either completely located intracranially or extended into the intracranial space. At 3 months, 64 of the 81 non-SAH patients (79%) had a favorable outcome (modified Rankin Scale, 0 to 2); 1 patient died of brain infarction in the acute stage. Only 1 aneurysm developed during follow-up in the non-SAH group, and no intracranial bleeding was observed during anticoagulant treatment. Those presenting with SAH formed 25% of all IADs, and 21 cases out of 22 (95%) were associated with ruptured fusiform dissecting aneurysm. This latter group displayed significantly worse outcomes: 7 died, and only 7 had modified Rankin Scale 0 to 2 at 3 months.

Conclusions--Our results provide important information for clinical practice. IADs appear to polarize into 2 groups: (1) nonaneurysmatic IADs presenting without SAH that are associated with favorable outcomes and safe anticoagulant therapy; and (2) aneurysmatic IADs, characterized by SAH and poorer prognosis. Literature on IADs may have been biased toward group 2.

Key words: anticoagulants • cervical artery • dissection • prognosis • stroke

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Anticoagulation in Cerebral Ischemia Associated With Intracranial Artery Dissections Is Safe, but Is It Enough to Recommend It?

Didier Leys and Stéphanie Debette
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