Conservative Management of Unruptured Spontaneous Intracranial Vertebral Artery Dissection

Abstract

OBJECTIVE: The present study investigated the clinical and morphological characteristics of the vertebrobasilar artery associated with vascular healing in patients with unruptured spontaneous intracranial vertebral artery (VA) dissection (VAD). METHODS: We retrospectively reviewed the data from 69 consecutive patients with a diagnosis of unruptured VAD who were treated conservatively for >/=21 days from November 2003 to February 2018 at our institute. Univariate and multivariate analyses were performed to evaluate the clinical characteristics and morphological findings of VAD. RESULTS: Of the 69 patients, vascular normalization of VAD was observed in 26, including a significantly greater proportion of women and nonsmokers (P = 0.04 and P = 0.034, respectively). Patients with normalization of VAD had a significantly lower proportion of posteroinferior cerebellar artery involvement and a smaller vertebral-union-basilar angle of the nondissecting VA, smaller vertebral-union-vertebral angle, distal dissection from the VA union, and less basilar artery bending. Luminal irregularity/steno-occlusion of the VAD on the initial images exhibited vascular resolution/normalization in 25 patients (67.6%) on subsequent images. The morphology of VAD in the dominant or codominant VAs included fusiform/aneurysmal dilatation in 25 patients (78.1%). The morphology in the nondominant VA included luminal irregularity/steno-occlusion in 23 patients (62.2%). CONCLUSIONS: Spontaneous vascular normalization of unruptured spontaneous intracranial VAD might be associated with female sex, nonsmoking, no posteroinferior cerebellar artery involvement, a smaller vertebral-union-basilar angle and vertebral-union-vertebral angle, distal dissection from the VA union, less basilar artery bending, and luminal irregularity/steno-occlusion.