Park Gi Jeong, Cho Jae Hoon, Kim Ki Hong
Department of Neurosurgery, Daegu Catholic University Hospital, Daegu, Korea.
J Cerebrovasc Endovasc Neurosurg. 2022 Mar;24(1):10-15. doi: 10.7461/jcen.2021.E2021.06.012. Epub 2021 Oct 26.
Vertebral artery dissecting aneurysm (VADA) is a rare and critical disease. VADA rupture can cause subarachnoid hemorrhage which is a major complication of VADA due to their high rebleeding rate and poor outcome. In the present study, ruptured and unruptured VADAs were compared by analyzing angiographic findings to determine useful predisposing factors for VADA rupture for appropriate treatment selection.
Subjects with VADA treated during a 10-year period were retrospectively identified. The 57 cases diagnosed with VADA were divided into ruptured (n=15) and unruptured (n=42) groups. In addition, each case was analyzed using angiographic 3-dimensional (3-D) reconstructed images. Factors such as length, dilated and stenotic diameter, shape, and vessel around the vertebral artery (VA) were measured and statistically compared.
In the ruptured group, stenotic findings of the affected lesion were more common and severe than in the unruptured group. The average stenotic diameter was 2.27 mm (vs. 2.84 mm). And stenotic degree was 62% and 53% in the ruptured and unruptured groups, respectively. Posterior communicating artery (PcomA) flow was more common in the ruptured group (87% vs. 55%, p=0.028). Conclusions: Based on angiographic findings, stenotic lesions, which may be influenced by PcomA flow, are more common in ruptured VADAs.
椎动脉夹层动脉瘤（VADA）是一种罕见且严重的疾病。VADA破裂可导致蛛网膜下腔出血，这是VADA的主要并发症，因其再出血率高且预后差。在本研究中，通过分析血管造影结果对破裂和未破裂的VADA进行比较，以确定VADA破裂的有用易感因素，从而选择合适的治疗方法。
回顾性确定10年间接受治疗的VADA患者。57例诊断为VADA的患者分为破裂组（n = 15）和未破裂组（n = 42）。此外，使用血管造影三维（3 - D）重建图像对每个病例进行分析。测量并统计比较病变长度、扩张和狭窄直径、形状以及椎动脉（VA）周围血管等因素。
在破裂组中，受累病变的狭窄表现比未破裂组更常见且更严重。平均狭窄直径为2.27mm（未破裂组为2.84mm）。破裂组和未破裂组的狭窄程度分别为62%和53%。后交通动脉（PcomA）血流在破裂组中更常见（87%对55%，p = 0.028）。结论：基于血管造影结果，受PcomA血流影响的狭窄病变在破裂的VADA中更常见。
