Clinical and radiological risk factors for rupture of vertebral artery dissecting aneurysm: significance of the stagnation sign

Hyeong Jin Lee MD1, Jai Ho Choi MD, PhD1, Kwan Sung Lee MD, PhD1, Bum Soo Kim MD, PhD2, and Yong Sam Shin MD, PhD1
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  • 1 Departments of Neurosurgery and
  • | 2 Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
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OBJECTIVE

The aim of this study was to investigate the clinical and radiological factors associated with the rupture of a vertebral artery dissecting aneurysm (VADA) and to evaluate whether the stagnation sign is a significant risk factor for rupture of VADA.

METHODS

Clinical and radiological variables of 117 VADAs treated in a tertiary hospital from September 2008 to December 2020 were retrospectively reviewed. The stagnation sign is defined as the finding of contrast agent remaining in the lesion until the venous phase of angiography. Univariate and multivariate analyses were executed to reveal the associations between rupture status and VADA characteristics.

RESULTS

The rate of ruptured VADAs was 29.1% (34 of 117) and the stagnation sign was observed in 39.3% (46 of 117). Fusiform shape (OR 5.105, 95% CI 1.591–16.383, p = 0.006), irregular surface (OR 4.200, 95% CI 1.412–12.495, p = 0.010), posterior inferior cerebellar artery (PICA) involvement (OR 3.788, 95% CI 1.288–11.136, p = 0.016), and the stagnation sign (OR = 3.317, 95% CI 1.131–9.732, p = 0.029) were significantly related to rupture of VADA in multivariate logistic regression analysis.

CONCLUSIONS

This study showed that fusiform shape, irregular surface, PICA involvement, and the stagnation sign may be independent risk factors for the rupture of VADA. Therefore, when the potential risk factors are observed in unruptured VADA, more aggressive treatment rather than follow-up or medical therapy may be considered.

ABBREVIATIONS

PICA = posterior inferior cerebellar artery; SAH = subarachnoid hemorrhage; VA = vertebral artery; VADA = vertebral artery dissecting aneurysm; WSS = wall shear stress; 3DRA = 3D rotational angiography.

Images from Minchev et al. (pp 479–488).

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