Introduction: We aimed to evaluate predictors of symptomatic intracranial spontaneous vertebral artery dissection aneurysm (sis-VADA) recurrence after reconstructive treatment.

Methods: A total of 111 patients(M:F=68:43; median age, 47 years) with 113 sis-VADAs underwent reconstruction using stent(s) and coils from October 2000 to March 2011. The treatments and predictors of recurrence were retrospectively analyzed.

Results: Fifty-eighty sis-VADAs underwent single-stent treatment, and the remaining 55 sis-VADAs underwent treatment with 2-4 overlapping stents. The post-treatment recurrence and mortality rates were nearly 10% (10/97) and 6% (7/111), respectively. Follow-up angiography was available for 94 sis-VADAs 12 -78 months (mean, 23 months) after treatment, and 10 patients occurred recurrence, including 7 angiographic recurrences and 3 post-treatment hemorrhagic recurrences. One and 2 of hemorrhagic recurrences initially presented with ruptured and un-ruptured forms, respectively. None of 3 hemorrhagic recurrences underwent follow-up angiography, and they all subsequently died. A higher rate of post-treatment recurrence was observed in single stent group than in multiple stents group (p<0.05). Partial obliteration after single stent treatment (odds ratio [OR] =3.152; 95% confidence interval [CI], 1.293-7.686; p=0.012), PICA-involving lesions reconstructed with single stent (OR=4.607; 95% CI, 1.172-18.113; p=0.029), and PICA-involving lesions with immediate partial obliteration (OR=5.018; 95% CI, 1.263-19.933; p=0.022) were independent predictors for recurrence in the reconstructed sis-VADAs.

Conclusions: Multiple stents had the clear preponderance over single stent in preventing recurrence. Partial obliteration after single stent treatment, PICA-involving lesions reconstructed with single stent, and PICA-involving lesions with immediate partial obliteration were independent predictors for recurrence after reconstructive treatment of sis-VADAs.

Patient Care: Advance(s) in knowledge (up to five numbered complete sentences) (i) Partial obliteration after single stent treatment (odds ratio [OR] =3.152; 95% confidence interval [CI], 1.293-7.686; p=0.012); (ii) PICA-involving lesions reconstructed with single stent (OR=4.607; 95% CI, 1.172-18.113; p=0.029); (iii) PICA-involving lesions with immediate partial obliteration (OR=5.018; 95% CI, 1.263-19.933; p=0.022).

Learning Objectives: We aimed to explain predictors of symptomatic intracranial spontaneous vertebral artery dissection aneurysm (sis-VADA) recurrence after reconstructive treatment.

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