Clinical significance of basilar artery aneurysms

Nijensohn, Daniel E.; Saez, Ruben J.; Reagan, Thomas J.

doi:10.1212/wnl.24.4.301

Cited by 110 publications

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“…However, the association between dolichoectasia and myocardial infarction has also been reported. 5,27 The reasons for the association between intracranial vascular dilation and coronary heart events are unclear. It might be explained by the fact that BA diameter was associated with carotid IMT, which is a strong predictor of myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Basilar Artery Diameter Is an Independent Predictor of Incident Cardiovascular Events

Tanaka

Sakaguchi²,

Miwa³

et al. 2013

ATVB

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In this study, we investigated the association between BA diameter and CSVD and cerebral large-vessel diseases through brain MRI and prospectively investigated the predictive value of BA diameter for subsequent cardiovascular events in patients with atherosclerotic risk factors. Materials and MethodsMaterials and Methods are available in the online-only Supplement.© 2013 American Heart Association, Inc. Objective-Basilar arterial (BA) dolichoectasia is associated with cerebral small-vessel disease and stroke. However, the association between moderate dilation of the BA and cerebral small-vessel disease or subsequent cardiovascular events remains unclear. This study aims to clarify the factors related to BA diameter and to clarify whether the BA diameter is an independent predictor of cardiovascular events. Approach and Results-The study subjects comprised 493 outpatients with atherosclerotic risk factors. BA diameter, lacunar infarct, severity of deep white matter hyperintensities, and intracranial steno-occlusive lesions were assessed with MRI and magnetic resonance angiography. Then, we prospectively evaluated the association between BA diameter and cardiovascular events. The BA diameter ranged from 1.1 to 5.2 mm, and only 0.8% of the patients had dolichoectasia. Male sex, the presence of lacunar infarcts, the severity of deep white matter hyperintensities, the fetal-type variation of the circle of Willis, and intracranial steno-occlusive lesions were independently associated with BA diameter. In the mean follow-up of 6.0 years, 91 patients developed cardiovascular events. BA diameter was independently associated with total cardiovascular events after adjusting for age, sex, and conventional risk factors (hazard ratio, 1.55 per 1 mm increase in BA diameter; P=0.009). Conclusions-Increased BA diameter within the normal range is related to both large-vessel disease and cerebral small-vessel disease, and it could be a new predictor of cardiovascular events. ResultsThe characteristics of the patients are shown in Table 1. The BA diameter ranged from 1.1 to 5.2 mm (median, 2.7 mm), and the distribution is also shown in Table 1. The variables associated with BA diameter in the univariate analysis were male sex, hypertension, smoking habit, history of ischemic heart disease and stroke, and body height. Also, lacunar infarct, severity of periventricular hyperintensities, deep white matter hyperintensities (DWMH), type of variation of the posterior circle of Willis, intracranial stenotic lesion assessed by MRI, and mean maximum intima-media thickness (IMT) and pulsatility index assessed by carotid ultrasound were associated with BA diameter (Table 2). The BA diameter was significantly smaller in the fetal type than in other variant types of the circle of Willis. In the multiple linear regression analysis, male sex, lacunar infarct, severity of DWMH, fetal-type variation, and intracranial stenotic lesion were independently associated with BA diameter (Table 3).In the follow-up study, the mean follow-up period was 6.0 y...

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Section: Discussionmentioning

confidence: 99%

Basilar Artery Diameter Is an Independent Predictor of Incident Cardiovascular Events

Tanaka

Sakaguchi²,

Miwa³

et al. 2013

ATVB

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“…Some authors 21,41 have suggested that atherosclerotic degeneration of the vascular wall, either alone or associated with arterial hypertension, is the initial pathogenetic factor in the development of this condition. Other authors maintain that atherosclerosis does not play a substantial role in the pathogenesis of arterial ectasia and that VBD is a congenital anomaly.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Bleeding associated with VBD has also been reported. 4,10,13,[17][18][19][20][21] There are many reports of patients with VBD complicated by compression of neural structures, whereas studies of ischemic complications are few and no attempt has been made to characterize this aspect. 4,9,11,13 This study was undertaken to systematically examine and characterize clinical and imaging findings in patients with stroke associated with VBD and to compare this data with that of patients with VBD but no stroke.…”

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confidence: 99%

Posterior Circulation Infarcts in Patients With Vertebrobasilar Dolichoectasia

Passero¹,

Filosomi²

1998

Stroke

108

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Background and Purpose-Vertebrobasilar dolichoectasia (VBD) may produce symptoms by direct compression of cranial nerves or the brain stem, by obstructive hydrocephalus, or by ischemia in the vertebrobasilar arterial territory. This study was undertaken to examine and characterize clinical and imaging findings in patients with stroke associated with VBD and compare these data with those for patients with VBD who did not have a stroke. Methods-We studied 40 consecutive stroke patients with associated VBD. All were evaluated by CT scan (nϭ9), MRI (nϭ6), or both (nϭ25). The diameter of the basilar artery (BA), height of bifurcation, and transverse position were evaluated. Clinical and imaging findings were compared with those found in a group of 40 VBD patients without stroke. Results-More than half of the patients (24 of 40) had infratentorial infarcts, located mainly in the midpons. Sixteen patients had supratentorial lesions localized in the thalamus (nϭ8) or in the superficial arterial territory of the posterior cerebral artery (PCA; nϭ8). The diameter and height of the bifurcation of the BA were correlated with the location of the lesion (PCA territory versus BA territory), in that severe ectasia and vertical elongation of the BA were significantly more often observed in patients with infarcts in PCA territory than in patients with infarcts in territories supplied by branches of the BA. Comparison of VBD patients with and without stroke showed that the incidence of arterial hypertension and the degree of ectasia and lateral displacement of the BA were not significantly different in the two groups. Patients with stroke more often had atherosclerotic changes of the posterior circulation (Pϭ.0006) and a higher degree of vertical elongation of the BA (Pϭ.025). Conclusions-In patients with VBD, superimposed atheromatous changes of the posterior circulation may have an important role in precipitating ischemia. However, other factors related to the severity of the dolichoectasia also favor ischemia and in some cases are the only factors responsible. (Stroke. 1998;29:653-659.)

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“…8 The five cases dolicho-ectatic anomaly was a primary dysplasia of the reported by Hayes et al 9 all had extensive atheroscle muscularis with secondary changes in the elastic tissue rosis. Nijensohn et al 10 reviewed the clinical and gross pathological features of 27 saccular and 23 fusiform basilar aneurysms. Fusiform aneurysms correlated with male sex, age over 60, atherosclerotic heart dis ease, and aneurysmal dilation of other vessels, espe cially the abdominal aorta.…”

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confidence: 99%

Fusiform basilar aneurysm as a cause of embolic stroke.

Steel¹,

Thomas²,

Strollo³

1982

Stroke

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SUMMARY Giant fusiform basilar aneurysms (dolicho-ectatic basilar anomalies) are rare and have not previously been reported to cause embolic infarction in territory distal to the aneurysm. They most commonly present as posterior fossa mass lesions with brainstem compression and cranial neuropathies. Originally considered atherosclerotic in etiology, recent authors feel that they may represent a unique arteriopathy characterized by loss of elastin in the vessel wall. We report a case which presented solely as an occipital lobe infarction. To our knowledge, this is the first case in which a fusiform basilar aneurysm presented with an embolic infarction as its only manifestation. Stroke, Vol 13, No 5, 1982 GIANT FUSIFORM BASILAR ANEURYSMS (doli cho-ectatic basilar anomalies') are aneurysmal dilations of the basilar artery and usually present clinically as posterior fossa mass lesions ( 5 Emboli arising from in tracerebral aneurysms are unusual 22 -23 and to our knowledge have not been reported originating from a fusiform basilar aneurysm. We report a case which presented solely as an embolic occipital lobe in farction.Case Report A 59-year-old man with mild hypertension and Type IV hyperlipidemia experienced abrupt onset of right periorbital headache accompanied by loss of vision in the left visual field. He had no previous history of transient ischemic attacks (TIAs) or stroke. Several weeks prior to the event, he noted frequent right peri orbital headachees lasting 45-60 minutes without neurologic symptoms. Nine years previously he under went surgery for repair of an abdominal aortic aneu rysm. His risk factors included a 20 year history of mild hypertension (highest recorded pressure 140/100 mg Hg), smoking, hypertriglyceridemia, and moder ate obesity. His general physical examination was normal ex cept for early retinal vessel sclerosis. Blood pressure was 130/84 mm Hg. There were no carotid bruits. Neurologic examination demonstrated a left superior _, quadrantanopsia, but was otherwise unremarkable.The following studies were normal: serum electro lytes, complete blood count, syphilis serology, urinal ysis, coagulation profile, echocardiogram, and lumbar puncture. Serum triglycerides were 261 mg/dl (nor mal, 30-150 mg/dl). The electrocardiogram demon strated borderline nonspecific ST-T wave changes and rare multifocal premature ventricular contractions.A computed tomographic (CT) scan of the head demonstrated a nonhemorrhagic right occipital lobe infarction ( fig. 1), and a large eccentrically positioned basilar artery, with calcification in its walls, extending well above the posterior clinoids ( fig. 2a). The contrast enhanced ( fig. 2b) and reformatted coronal ( fig. 3) images revealed the presence of incomplete thrombo sis in the aneurysm which measured up to 2 cm in diameter. Pancerebral angiography ( fig. 4) confirmed the diagnosis of a partially thrombosed giant fusiform basilar aneurysm and showed the lesion to be continu ous with an ectatic and elongated dominant right verte bral artery. In additio...

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Clinical significance of basilar artery aneurysms

Cited by 110 publications

References 0 publications

Basilar Artery Diameter Is an Independent Predictor of Incident Cardiovascular Events

Basilar Artery Diameter Is an Independent Predictor of Incident Cardiovascular Events

Posterior Circulation Infarcts in Patients With Vertebrobasilar Dolichoectasia

Fusiform basilar aneurysm as a cause of embolic stroke.

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