Dolichoectasia—an evolving arterial disease

Abstract

Dolichoectasia is an arterial disease that causes dilatation and/or tortuosity of the affected vessel. The prevalence of dolichoectasia increases with age, and this disease is also associated with other traditional cardiovascular risk factors. Multiple pathophysiological processes might lead to the development of dolichoectatic vessels, and activation of metalloproteinases and irregular turbulent blood flow seem to cause irreversible disruption of the internal elastic lamina. Intracranial dolichoectasia commonly presents with ischemic or hemorrhagic stroke, and/or cranial neuropathies. The posterior circulation is more frequently affected by the dolichoectatic process than the anterior circulation. A positive diagnosis of dolichoectasia requires visual assessment of vessel shape and, if the posterior circulation is affected, application of Smoker's criteria. Reproducible criteria that aid diagnosis of dolichoectasia in the anterior circulation are lacking. No specific treatment for dolichoectasia exists, and the surgical and medical therapies that have been used to treat this condition have not been systematically evaluated. More evidence is needed to better understand the underlying dilatatory artheriopathy that causes this disease, and to determine whether patients with dolichoectasia might benefit from early diagnosis. In this article, we provide a comprehensive review of current knowledge regarding dolichoectasia, and highlight gaps in our knowledge to aid future research.

Perfusion by delayed time to peak in vertebrobasilar dolichoectasia patients with vertigo

“…In addition, we did not found that BAL, BL or TI of the BA were the risk factors of posterior circulation ischemic stroke, suggesting that dilation of BA was associated with perfusion of posterior circulation but tortuosity and elongation were not associated with the perfusion in territories of posterior circulation. A recent review on dolichoectasia demonstrated that dolichoectatic vessels that had large diameters seem to be associated with the greatest risk of stroke, while novel elongation and tortuosity were associated with compressive cranial neuropathies,1 this may support our findings. Though some VBD patients were involved with vertebral artery and some patients were determined to be ischemic stroke located in the areas fed by vertebral artery, we did not find that dilation or tortuosity of vertebral artery was the risk of posterior circulation ischemic stroke.…”

“…Increased BA diameter is the risk factor of future stroke 1, 18. In the GENIC study, Pico et al19 even found that BA diameter was associated with an increased 5‐year stroke mortality rate in patients with stroke and a diameter >4.3 mm might be a marker for a high risk of fatal stroke.…”

“…Vertebrobasilar dolichoectasia (VBD) was a clinical entity characterized by elongated, dilated and/or tortuous vertebral artery, and basilar artery (BA),1, 2, 3 ranging from 0.05% to 18% 4, 5, 6. VBD presentation includes symptoms by cerebral ischemia in the vertebrobasilar territory 2, 3, 4, 5, 6…”

Imaging Characteristics of Growing and Ruptured Vertebrobasilar Non-Saccular and Dolichoectatic Aneurysms

“…Growing lesions are generally associated with high rates of rupture, ischemic stroke, and compressive symptoms, and imaging follow-up could potentially be used to identify at-risk lesions so that therapies can be put in place to mitigate the poor natural history of these lesions. 1,5,8,22,23 It is important to note, however, that there are no specific medical, surgical, or endovascular therapies specific to the treatment of VBDAs. In terms of stroke prevention, some studies have suggested that anticoagulation and antiplatelet therapy are not effective in preventing stroke in VBDAs and may be associated with higher hemorrhage rates, 24,25 whereas other studies have suggested that anticoagulation may be protective against mortality.…”

Endovascular Reconstruction for Treatment of Vertebrobasilar Dolichoectasia: Long-Term Outcomes

“…9 This study retrospectively reviewed the clinical and imaging data of 9 patients with VBD who were treated with coil-assisted stent reconstruction in the vascular lumen, in an attempt to explore the feasibility and long-term effectiveness of this technique in preventing ischemic events in stented vessels.…”