Oshita Shu, Yumoto Tetsuya, Jinno Shunta, Matsuo Ippei, Hongo Takashi, Naito Hiromichi, Hiramatsu Masafumi, Haruma Jun, Sugiu Kenji, Tanaka Shota, Nakao Atsunori
Okayama University Medical School Okayama Japan.
Department of Emergency, Critical Care, and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan.
Acute Med Surg. 2024 Dec 26;11(1):e70031. doi: 10.1002/ams2.70031. eCollection 2024 Jan-Dec.
Vertebral artery dissection (VAD) is a rare cause of non-traumatic subarachnoid hemorrhage (SAH) with significant clinical implications. This study compared the clinical characteristics and outcomes of SAH from intracranial VAD rupture to those from other etiologies, primarily aneurysmal rupture.
This single-center retrospective cohort study at Okayama University Hospital included patients with non-traumatic SAH diagnosed between 2019 and 2023. Patients were categorized into "VAD rupture" and "other etiologies" groups. The main outcome was clinical presentation and symptoms. Additional outcomes included ICU mortality, in-hospital mortality, and unfavorable outcomes at discharge and 6 months, defined as a modified Rankin Scale score of 3-6.
A total of 66 patients were included, with 14 in the VAD rupture group and 52 in the other etiologies group. The VAD rupture group was younger (median age 49 vs. 64 years, = 0.003) and had a higher incidence of out-of-hospital cardiac arrest (42.9% vs. 9.6%, = 0.011). Preceding headache was more common in the VAD rupture group (78.6% vs. 11.5%, < 0.001), with a median duration of 36 h before presentation. ICU and in-hospital mortality was higher in the VAD rupture group (both 50.0% vs. 19.3%, = 0.019). No significant differences were found in unfavorable neurological outcomes at hospital discharge and 6 months.
VAD-related SAH often presents with prodromal headaches, severe symptoms like out-of-hospital cardiac arrest, and higher ICU and in-hospital mortality than other SAH causes, though long-term outcomes are similar. Larger, prospective studies are needed to refine interventions.
椎动脉夹层（VAD）是非创伤性蛛网膜下腔出血（SAH）的罕见病因，具有重要的临床意义。本研究比较了颅内VAD破裂所致SAH与其他病因（主要是动脉瘤破裂）所致SAH的临床特征和结局。
本项在冈山大学医院开展的单中心回顾性队列研究纳入了2019年至2023年期间诊断为非创伤性SAH的患者。患者被分为“VAD破裂”组和“其他病因”组。主要结局是临床表现和症状。其他结局包括重症监护病房（ICU）死亡率、住院死亡率以及出院时和6个月时的不良结局，不良结局定义为改良Rankin量表评分为3 - 6分。
共纳入66例患者，其中VAD破裂组14例，其他病因组52例。VAD破裂组患者更年轻（中位年龄49岁对64岁，P = 0.003），院外心脏骤停发生率更高（42.9%对9.6%，P = 0.011）。VAD破裂组前驱头痛更常见（78.6%对11.5%，P < 0.001），出现症状前的中位持续时间为36小时。VAD破裂组的ICU死亡率和住院死亡率更高（均为50.0%对19.3%，P = 0.019）。出院时和6个月时的不良神经功能结局无显著差异。
与VAD相关的SAH常伴有前驱头痛、院外心脏骤停等严重症状，且ICU死亡率和住院死亡率高于其他SAH病因，不过长期结局相似。需要开展更大规模的前瞻性研究以优化干预措施。
