Strategy for treating unruptured vertebral artery dissecting aneurysms

Area of Science:

• Neurology
• Vascular Surgery
• Neuroradiology

Background:

• The natural history of unruptured vertebral artery dissecting aneurysms (VADAs) is not well understood.
• Clarifying the course of VADAs is crucial for effective treatment strategies.

Purpose of the Study:

• To establish a treatment strategy for unruptured VADAs using long-term patient follow-up.
• To analyze the natural progression and outcomes of conservative versus interventional management.

Main Methods:

• Retrospective analysis of 100 patients with unruptured VADAs, presenting with headache, ischemic symptoms, or mass effect.
• Serial magnetic resonance imaging and angiography were used to monitor dissection site changes over 24 months.
• Intervention was considered for enlarging dissections without new symptoms.

Main Results:

• Most patients (96/100) were initially treated conservatively, with 9 undergoing later intervention for lesion enlargement.
• Conservative management led to stability, improvement, or healing in the majority of VADAs (91/96).
• No cases of bleeding or permanent neurological deficits were observed; antiplatelet therapy was used for recurrent ischemic attacks.

Conclusions:

• Unruptured VADAs generally follow a non-aggressive course.
• Enlargement of the dissection site, even without new symptoms, warrants consideration for occlusion.
• Antiplatelet therapy is a viable option for patients experiencing recurrent ischemic events.