• Yasushi Motoyama, Yoshiaki Takamura, Hun Soo Park, Toshiteru Miyasaka, Takeshi Wada, Shuichi Yamada, Kozue Saito, Ichiro Nakagawa, Young-Su Park, Kazuma Sugie, and Hiroyuki Nakase.
• Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan; Stroke Center, Nara Medical University, Kashihara, Nara, Japan. Electronic address: myasushi@naramed-u.ac.jp.
• World Neurosurg. 2019 Oct 1; 130: e627-e633.

BackgroundMedullary infarction (MI) occasionally occurs after treatment of ruptured vertebral artery dissection (VAD). The aim of this study was to validate whether flow reduction for ruptured unilateral VAD by proximal clipping prevents rebleeding and MI in comparison with trapping.MethodsThirty-one patients who underwent direct surgery or endovascular procedures for unilateral ruptured VAD and postoperative magnetic resonance imaging (MRI), including 9 patients treated with trapping and 22 patients treated with proximal clipping, were enrolled. For posterior inferior cerebellar artery (PICA)-involved type VAD, occipital artery to PICA anastomosis was added as needed to isolate the rupture point. The rate of rebleeding and the occurrence of MI on MRI were compared between the 2 groups.ResultsThere was no rebleeding after treatment in all 31 patients. However, 5 patients had MI on postoperative MRI (16.1%, κ = 0.903). In 5 of the 9 patients treated with trapping, MI was seen on MRI after treatment (55.6%). On the other hand, 0 of the 22 patients treated with proximal clipping developed MI (P < 0.01).ConclusionsAppropriate flow reduction for ruptured unilateral VAD by proximal clipping is thought to be effective for preventing rebleeding and avoiding MI.Copyright © 2019 Elsevier Inc. All rights reserved.

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