J Neurosurg 142:1376–1386, 2025
This multinational study of 382 patients reveals dolichoectatic vertebrobasilar aneurysms (DVBAs) have a high annual mortality (10.8%) and morbidity (1.6%). Advanced age (>50 years), basilar artery location, and large aneurysm size predict worse outcomes, supporting early invasive treatment when feasible to improve prognosis.
• Dolichoectatic vertebrobasilar aneurysms (DVBAs) are rare, malignant vascular lesions with high morbidity and mortality.
• Largest multinational study to date analyzed 382 patients with DVBAs from 11 centers in Europe, US, and Japan.
• Most patients were male (68.6%), median age at diagnosis was 58.8 years.
• Annual adverse event, mortality, and morbidity rates were 12.4%, 10.8%, and 1.6% respectively.
• Older age (>50 years), basilar artery location, larger aneurysm size (>25 mm), and type II (dolichoectatic) morphology were key risk factors for poor outcomes.
• Highest risk of adverse events and death occurred within the first year after diagnosis, especially in older patients and those with basilar artery involvement.
• Early invasive treatment is encouraged when feasible, based on age and radiological characteristics.
• Study highlights urgent need for new, safer therapeutic options for DVBAs.
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