Enlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth

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Object. Vertebrobasilar nonsaccular intracranial aneurysms (NIAs) are characterized by elongation, dilation, and tortuosity of the vertebrobasilar arteries. The goal of this study was to define the frequency, predictors, and clinical outcome of the enlargement of vertebrobasilar NIAs.

Methods. Patients with vertebrobasilar fusiform or dolichoectatic aneurysms demonstrated on imaging studies between 1989 and 2001 were identified. In particular, patients who had undergone serial imaging were included in this study and their medical records were retrospectively reviewed. Prospective information was collected from medical records or death certificates when available. Both initial and serial imaging studies were reviewed. The authors defined NIA enlargement as a change in lesion diameter greater than 2 mm or noted on the neuroradiologist's report. A Cox proportional hazards regression was used to model time from diagnosis of the vertebrobasilar NIA to the first documented enlargement as a function of various predictors. The Kaplan-Meier method was used to study patient death as a function of aneurysm growth.

Of the 159 patients with a diagnosis of vertebrobasilar NIA, 52 had undergone serial imaging studies including 25 patients with aneurysm enlargement. Lesion growth significantly correlated with symptomatic compression at the initial diagnosis (p = 0.0028), lesion type (p < 0.001), and the initial maximal lesion diameter (median 15 mm in patients whose aneurysm enlarged compared with median 8 mm in patients whose aneurysm did not enlarge; p < 0.001). The mortality rate was 5.7 times higher in patients with aneurysm growth than in those with no enlargement after adjustment for patient age (p = 0.002).

Conclusions. Forty-eight percent of vertebrobasilar NIAs demonstrated on serial imaging enlarged, and this growth was associated with significant morbidity and death. Significant risk factors for aneurysm enlargement included symptomatic compression at the initial diagnosis, transitional or fusiform vertebrobasilar NIAs, and initial lesion diameter. Further studies are necessary to determine appropriate treatments of this disease entity once enlargement has been predicted or occurs.

Article Information

Address reprint requests to: Kelly D. Flemming, M.D., Mayo Building, W8B, 200 First Street SW, Rochester, Minnesota 55905. email: Flemming.Kelly@mayo.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Artist's renditions of the classification scheme of Flemming, et al. Left: Fusiform aneurysm. Dilation 1.5 times the normal diameter without a definable neck and involving a portion of an arterial segment (either a VA or BA), with any degree of tortuosity. Center: Dolichoectatic aneurysm. Uniform dilation of an artery greater than 1.5 times its normal diameter and involving the entire BA or VA or both, with any degree of tortuosity. Right: Transitional aneurysm. Uniform aneurysm dilation of an entire arterial segment greater than 1.5 times its normal size and involving the VA, BA, or both, with superimposed dilation of a portion of the involved arterial segment.

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    Chart indicating the timing of each patient's first documented aneurysm growth, review of cross-sectional (CS) film, and death. The horizontal axis represents the time from diagnosis in years (y), and the vertical axis represents the 52 patients in the study. The upper half of the chart (Cases 28–52) includes the patients with aneurysm growth, whereas the lower half includes the patients without lesion growth. Dx = diagnosis.

  • View in gallery

    Magnetic resonance images obtained in a 74-year-old man with a transitional type of vertebrobasilar NIA. Initially, the patient was asymptomatic in September 2000 when the lesion was discovered on an MR image (left) obtained in an Alzheimer research study. Subsequently, the patient displayed compressive symptoms and an event believed to be a transient ischemic attack in December 2002 (right).

  • View in gallery

    A T1-weighted MR image obtained in a patient with a vertebrobasilar NIA that later enlarged. Note the abnormal high signal intensity at the aneurysm rim (arrow).

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