Abstract
Background: Intracranial vertebral artery dissection aneurysms (VADAs) may cause acute ischemia or hemorrhage, in which case urgent endovascular treatment will be needed. Although the majority of patients obtain a good functional outcome after surgery, a surprising finding has been a poor quality of life (QOL) in follow-up. The purpose of this study was to evaluate clinical efficacy in reconstructive endovascular therapy for acute intracranial VADAs and to analyze the factors contributing to subsequent QOL.Methods: In this prospective study, 33 consecutive VADA patients with subarachnoid hemorrhage were recruited for comparison with 37 VADA patients with posterior circulation cerebral ischemia. All VADA patients were treated using a reconstructive strategy. Clinical, radiological, neurological, and cognitive data, as well as QOL, were assessed at admission and 6 months after surgery. Stoke Specific Quality of Life (SS-QOL) was evaluated for patients with good functional outcome [modified Ranking Scale (mRS) scoring 0-2] for subgroup analysis. Predictors for QOL at follow-up were analyzed by regression model.Results: Immediate angiography after surgery showed complete VADA obliteration in 57 (81.4%) patients and partial obliteration in 13 (18.6%) patients. Three (4.3%) cases suffered from perioperative complications, comprising two cases of stent thrombosis in the hemorrhagic group and one case of posterior inferior cerebellar artery occlusion in the ischemic group. Twenty-five (75.8%) patients in the hemorrhagic group and 30 (81.1%) patients in the ischemic group had a favorable outcome (mRS scoring 0-2) at 6-month follow-up. Follow-up angiography displayed that one case of recurrence occurred separately in both groups. Fifteen of the 33 hemorrhagic patients (45.5%) and 19 of the 37 ischemic patients (51.4%) rated QOL at follow-up as bad (SS-QOL score ≤ 3.9) despite a good functional outcome. Severity of neurological disorder and impaired neurocognition at baseline in VADA patients are proved to be independent predictors for the decline of QOL according to regression analysis.Conclusion: Reconstructive endovascular therapy for acute intracranial VADAs is a safe and effective method with a low complication rate. VADAs lead to impaired QOL at 6-month follow-up, which is attributable to multiple factors. This study demonstrated that neurological and cognitive status at baseline is of significant importance for QOL after VADAs.
Highlights
Intracranial vertebral artery dissection aneurysms (VADAs) are increasingly diagnosed where there is presentation with subarachnoid hemorrhage and posterior circulation ischemia [1, 2]
The acute subarachnoid hemorrhage in group H patients was confirmed by computed tomography (CT), and the group I patients were diagnosed on the basis of acute cerebral infarction in a posterior blood supply area being seen in a magnetic resonance image (MRI) or transient ischemic attack (TIA) of the posterior circulation
We found that neurocognition and neurological function status at baseline were predictive factors of quality of life in intracranial VADA patients after endovascular reconstructive therapy
Summary
Intracranial vertebral artery dissection aneurysms (VADAs) are increasingly diagnosed where there is presentation with subarachnoid hemorrhage and posterior circulation ischemia [1, 2]. Intracranial VADAs can result in an acute cerebrovascular event, especially in middle-aged patients, and are associated with high mortality and morbidity due to the risk of recurrent bleeding [4, 5]. Endovascular therapy, including deconstructive and reconstructive methods, is favored for the treatment of intracranial VADAs [6]. Most intracranial VADAs can be treated with a deconstructive approach, a cerebrovascular ischemic event and re-bleeding still happen in some patients [7]. Intracranial vertebral artery dissection aneurysms (VADAs) may cause acute ischemia or hemorrhage, in which case urgent endovascular treatment will be needed.
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