Abstract
BACKGROUND: Dolichoectatic vertebrobasilar aneurysms (DVBAs) carry high morbidity, and treatment options are limited. The tumor necrosis factor α signaling cascade is implicated in DVBA growth and rupture, but the role of anti-tumor necrosis factor α therapy in DVBA has not been studied. METHODS: A retrospective, case-control study of DVBA at a single institution was performed. Two patients with DVBA were treated with infliximab (tumor necrosis factor α inhibitor) as part of routine therapy for rheumatoid arthritis. Three additional patients diagnosed with DVBA were studied as a control group. Routine brain magnetic resonance imaging/magnetic resonance angiography were measured by 2 blinded neuroradiologists to assess DVBA growth. Baseline comorbidities and clinical outcomes were assessed by chart review. RESULTS: The groups were similar with respect to baseline characteristics, and all patients were symptomatic at the time of DVBA diagnosis. One patient who started infliximab during the study period showed a reversal in DVBA growth rate trajectory, with a relative decrease in growth rate by 37% (0.49-0.18 mm(2)/day). Mean interval DVBA growth rates were lower during infliximab therapy than during noninfliximab observation intervals (0.13 versus 0.50 mm(2)/day; P = 0.09). Two patients in the control group died during the study period and 1 had a poor outcome (modified Rankin scale = 4). Both patients in the infliximab group had unchanged functional status (modified Rankin scale = 1) and no adverse events related to infliximab. CONCLUSION: This study presents the first investigation of anti-tumor necrosis factor α therapy for DVBA. Infliximab was associated with low and decreasing DVBA growth trajectories with no treatment-related adverse events. The effect of infliximab on clinical outcomes remains uncertain.