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Aneurysmal forms of cervical artery dissection : associated factors and outcome
Insights
Aneurysms from cervical artery dissection (CAD) often persist but pose a low clinical risk. This study assessed outcomes and factors associated with these aneurysms, finding a favorable prognosis despite persistence.
Area of Science:
- Vascular Neurology
- Neuroradiology
- Cerebrovascular Diseases
Background:
- The natural history of aneurysmal cervical artery dissection (CAD) is not well understood.
- Aneurysms can form in extracranial internal carotid artery (ICA) and vertebral artery (VA) dissections.
- Understanding their clinical and anatomical course is crucial.
Purpose of the Study:
- To evaluate the clinical and anatomical outcomes of aneurysmal forms of extracranial ICA and VA dissections.
- To identify factors associated with the development of aneurysmal CAD.
- To inform treatment decisions by clarifying the natural history.
Main Methods:
- Retrospective review of 71 consecutive patients with CAD.
- Identification of aneurysmal forms by two neuroradiologists using angiograms.
- Comparison of risk factors, multiple dissections, and arterial redundancies between patients with and without aneurysms.
- Clinical and radiological follow-up of patients with aneurysms.
Main Results:
- 49.3% of patients (35/71) had 42 aneurysms; 30 on symptomatic arteries (23 ICA, 7 VA) and 12 on asymptomatic arteries (10 ICA, 2 VA).
- Patients with aneurysms more frequently had multiple cervical vessel dissections (P=0.005) and arterial redundancies (P=0.02).
- Over a mean follow-up of >3 years, no patient experienced cerebral ischemia, local compression, or rupture; 83% of VA aneurysms resolved vs. 36% of ICA aneurysms.
Conclusions:
- Aneurysms resulting from CAD frequently persist over time.
- Despite persistence, the risk of clinical complications such as ischemia or rupture is very low.
- The favorable clinical outcome suggests caution regarding potentially harmful treatments.
Background And Purpose:
The natural history of aneurysmal forms of cervical artery dissection (CAD) is ill defined. The aims of this study were to assess (1) clinical and anatomic outcome of aneurysmal forms of extracranial internal carotid artery (ICA) and vertebral artery (VA) dissections and (2) factors associated with aneurysmal forms of CAD.
Methods:
Seventy-one consecutive patients with CAD were reviewed. Aneurysmal forms of CAD were identified from all available angiograms by 2 neuroradiologists. The frequency of arterial risk factors, of multiple vessel dissections, and of artery redundancies was compared in patients with and without aneurysm. Patients with aneurysm were invited by mail to undergo a final clinical and radiological evaluation.
Results:
Of the 71 patients, 35 (49.3%) had a total of 42 aneurysms. Thirty aneurysms were located on a symptomatic artery (ICA, 23; VA, 7) and 12 on an asymptomatic artery (ICA, 10; VA, 2). Patients with aneurysm had multiple dissections of cervical vessels (18/35 versus 7/36; P:=0.005) and arterial redundancies (20/35 versus 11/36; P:=0.02) more frequently than patients without aneurysm. They were also more often migrainous (odds ratio=2.7 [95% CI, 0.8 to 8.5]) and tobacco users (odds ratio=2.2 [95% CI, 0.7 to 6.3]). Clinical and anatomic follow-up information was available for 35 (100%) and 33 patients (94%), respectively. During a mean follow-up of >3 years, no patient had signs of cerebral ischemia, local compression, or rupture. At follow-up, 46% of the aneurysms involving symptomatic ICA were unchanged, 36% had disappeared, and 18% had decreased in size. Resolution was more common for VA than for ICA aneurysms (83% versus 36%). None of the aneurysms located on an asymptomatic ICA had disappeared.
Conclusions:
Although aneurysms due to CAD frequently persist, patients carry a very low risk of clinical complications. This favorable clinical outcome should be kept in mind before potential harmful treatment is contemplated.