It is well-known that outcomes of the ruptured dissecting aneurysms are quite poor, and that rebleeding of the aneurysms is one of the important prognostic factors in this disease. We conducted this study to elucidate the clinical and radiological features of the patients with rebleeding.
Forty-two patients with ruptured dissecting aneurysms in the vertebrobasilar system were analyzed. Ages ranged from 35 to 73 years (mean=50.9±8.4 years). Twenty-eight patients were treated surgically and the other 14 were treated conservatively. Among these 42 patients, 12 (29%) had rebleeding. The rebleeding was confirmed on CT scan. The outcome was evaluated by a Glasgow Outcome Scale. The mean follow-up period was 6.8±4.4 years.
Results: Among 42 patients, 25 (60%) achieved a good recovery, and 6 (14%) had died at 6 months after onset. The causes of death were rebleeding in 4 and vasospasm in 2. These outcomes were well correlated with the neurological severity (Hunt and Hess grade on admission). None, except for 1 aged patient, had deteriorated on long-term follow-up. Twelve patients with rebleeding had significantly poorer outcomes than the other 30 without it (p<0.01). The significant clinical and radiological features in the patients with rebleeding were as follows: poorer neurological grade (p<0.025), higher incidence of right vertebral artery dissection (p<0.05), and pearl and string sign as the angiographical finiding (p<0.01). Proximal occlusion was the most common procedure (68%) in the 28 surgically treated patients. Seventeen (60%) recovered well and none had been aggravated after the operation in these patients. Among the 14 conservatively treated patients, 8 (57%) made a good recovery on long-term follow-up.
These results suggest that the patients with rebleeding had poorer outcomes and might have the specific clinical and radiological features. It should be important to recognize these features, when considering the management strategy, because most of the patients who were treated conservatively made a good recovery on long-term follow-up in ruptured dissecting aneurysms of the vertebrobasilar system.
