Natural history of dolichoectatic vertebrobasilar aneurysms: a multinational study

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Dolichoectatic vertebrobasilar aneurysms (DVBAs) present unique challenges due to their morphology and poorly understood natural history.
• Patients often experience thromboembolic events or neurological deficits from mass effect.
• Lack of international data hinders optimal treatment timing decisions.

Purpose of the Study:

• To define the natural history of DVBAs through long-term follow-up.
• To identify risk factors influencing patient outcomes in a large, international cohort.
• To establish a new classification system for DVBAs based on radiological features.

Main Methods:

• International data collection from 382 patients across 11 centers (Europe, US, Japan).
• Longitudinal follow-up assessing stroke, neurological decline, and mortality.
• Exclusion of treated patients to focus on natural history; analysis of 221 patients with 622.3 patient-years follow-up.
• Kaplan-Meier and Cox regression analyses for risk factor identification.

Main Results:

• Annual mortality and morbidity rates were 10.8% and 1.6%, respectively.
• Age 50 years and older and larger DVBA maximum diameter were significant predictors of mortality and adverse events.
• A new classification system incorporating age and radiological characteristics impacted the understanding of DVBA natural history.

Conclusions:

• DVBAs exhibit aggressive behavior, necessitating consideration of early invasive treatment.
• Radiological characteristics and patient age are critical factors in treatment decisions.
• Further research is crucial for developing novel, safe therapeutic strategies for DVBAs.