Aneurysmal forms of cervical artery dissection - Associated factors and outcome

Background and Purpose-The natural history of aneurysmal forms of cervical artery dissection (CAD) is ill defined. The aims of this study were to asse ss (1) clinical and anatomic outcome of aneurysrual forms of extracranial i nternal carotid artery (ICA) and vertebral artery (VA) dissections and (2) factors associated with aneurysmal forms of CAD. Methods-Seventy-one consecutive patients with CAD were reviewed, Aneurysmal forms of CAD were identified from all available angiograms by 3 neuroradio logists, The frequency of arterial risk factors, of multiple vessel dissect ions, and of artery redundancies was compared in patients with and without aneurysm. Patients with aneurysm were invited by mail to undergo a final cl inical and radiological evaluation. Results-Of the 71 patients, 35 (49.3%) had a total of 12 aneurysms. Thirty aneurysms were located on a symptomatic artery (ICA, 23; VA, 7) and 12 on a n asymptomatic artery (ICA, 10; VA, 2), Patients with aneurysm had multiple dissections of cervical vessels (18/35 versus 7/36; P = 0.005) and arteria l redundancies (20/35 versus 11/36; P = 0.02) more frequently than patients without aneurysm. They were also more often migrainous (odds ratio = 2.7 [ 95% CI, 0.8 to 8.5]) and tobacco users (odds ratio = 2,2 [95% CI, 0.7 to 6. 3]). Clinical and anatomic follow-up information was available for 35 (100% ) and 33 patients (94%), respectively, During a mean follow-up of >3 years, no patient had signs of cerebral ischemia, local compression, or rupture. At follow-up, 46% of the aneurysms involving symptomatic ICA were unchanged , 36% had disappeared, and 18% had decreased in size. Resolution was more c ommon fur VA than for ICA aneurysms (83% versus 36%), None of the aneurysms located on an asymptomatic ICA had disappeared, Conclusions-Although aneurysms due to CAD frequently persist, patients carr y a very: low risk of clinical complications. This favorable clinical outco me should be kept in mind before potential harmful treatment is contemplate d.