Introduction: Dissection of the carotid and vertebral arteries can result in the development of aneurysmal dilatation. These dissecting pseudoaneurysms can enlarge and cause symptoms. The objective of this study is to provide an insight on the natural history of dissecting pseudoaneurysms and the treatments required to manage them.
Methods: Review of electronic medical records was conducted to detect patients with carotid and vertebral dissection. Imaging review was conducted to identify patients with dissecting pseudoaneurysms. 112 patients with 120 dissecting pseudoaneurysms were identified. Univariate and multivariate analyses were conducted to assess predictors of requiring an intervention other than medical treatment, aneurysm enlargement, becoming symptomatic and unfavorable outcome (mRS 2-6).
Results: 18.3% of pseudoaneurysms were intracranial and 81.7% were extracranial. The average size was 7.3 mm. Mean follow-up time was 29.3 months. 17.8% of pseudoaneurysms became symptomatic and 13.8% were found to have enlarged during follow-up. 20.8% required an intervention other than medical treatment. Interventions included stenting, coiling, pipeline embolization device and clipping. Aneurysms that did not require intervention were found to be stable in 70.3% and healed in 29.7% on follow-up imaging. Predictors of requiring an intervention included increasing size (OR=1.3,P=0.001,[1.12-1.54]), location in C2 segment of the ICA (OR=5.4,P=0.012,[1.4-20.1]), younger age (OR=1.07, P=0.04, [1.002-1.14]) and symptom development ( OR=58,P=0.000,[8-424]). Additionally in univariate analysis, size > 10mm (OR=7.4,P=0.000,[2.5-21.7]) was a significant predictor. Significant predictors of enlargement included smoking (OR=15.8,P=0.018,[1.6-156.6], history of trauma (OR=26.8,OR=0.009,[2.3-313.3]), increasing size (OR=1.44,P=0.001,[1.16-1.79]) and C2 location (OR=15,P=0.016, [1.7-141.7]). In univariate analysis size >10mm (OR=10.5,P=0.000,[3-36.4]) was also a significant factor. Predictors of becoming symptomatic included increasing size (OR=1.1, P=0.037, [1.005-1.21], C2 location (OR=4.4, P=0.026, [1.2-16.1]. Smoking was a predictor of unfavorable outcome. (OR=3.6,P=0.04,[1.02-13]).
Conclusions: Dissecting pseudoaneurysms have a benign course and most will not cause symptoms and enlarge on follow-up. Medical treatment can be sufficient as an initial treatment for dissecting pseudoaneurysms.
Patient Care: It will guide physicians in dealing with cases of pseudoaneurysm development in patients with carotid or vertebral dissection.
Learning Objectives: To assess the natural history of dissecting pseudoaneurysms and identify significant factors that may influence treatment and stability of these lesions.