The research aimed to look into the clinical and radiological factors linked to the rupture of a vertebral artery dissecting aneurysm (VADA) and see if the stagnation sign is a substantial risk factor for VADA rupture. Clinical and radiological data of 117 VADAs treated in a tertiary hospital were reviewed retrospectively from September 2008 to December 2020. A contrast agent in the lesion until the venous phase of angiography is known as the stagnation sign. Univariate and multivariate analyses uncovered connections between rupture status and VADA characteristics.

VADAs burst 29.1% of the time (34 of 117), while the stagnation indication was seen in 39.3% of the time (46 of 117). In multivariate logistic regression analysis, fusiform shape (OR 5.105, 95% CI 1.591–16.383, p = 0.006), irregular surface (OR 4.200, 95% CI 1.412–12.495, p = 0.010), posterior inferior cerebellar artery (PICA) involvement (OR 3.788, 95% CI 1.288–11.136, p = 0.016), and the stagnation sign (OR = 3.317, 95% CI 1.131–9.732, p = 0.029). In this investigation, the fusiform shape, irregular surface, PICA involvement, and the stagnation sign were independent risk factors for VADA rupture. When potential risk factors are discovered in unruptured VADA, using a more aggressive treatment strategy than follow-up or medication is good.