Recurrent risk of ischemic stroke due to Vertebrobasilar Dolichoectasia

Abstract

Background Patients with vertebrobasilar dolichoectasia usually have persistent hemodynamic abnormalities, and therefore, may bear an increased risk of stroke. This study aimed to identify risk factors for stroke recurrence in patients with vertebrobasilar dolichoectasia. Methods Patients with acute ischemic stroke were screened and evaluated for eligibility. Enrolled patients were followed via scheduled clinical visits or telephone interviews. Ischemic stroke recurrence was proposed with clinical symptoms and confirmed with cranial Magnetic Resonance Imaging or Computerized Tomography scans. Baseline characteristics and vascular geometry were compared between patients with and without stroke recurrence. Significant parameters were introduced into COX proportional hazard model to detect possible predictors of stroke recurrence. Results A total of 115 stroke patients with vertebrobasilar dolichoectasia were enrolled, of which 22 (19.1%) had recurrence during 22 ± 6 months follow-up. Basilar artery diameter ≥ 5.3 mm (HR = 4.744; 95% CI, 1.718–13.097; P = 0.003), diffuse intracranial dolichoectasia (HR = 3.603; 95% CI, 1.367–9.496; P = 0.010) and ischemic heart disease history (HR = 4.095; 95% CI, 1.221–13.740; P = 0.022) had increased risk of recurrence. Conclusions Stroke patients with vertebrobasilar dolichoectasia may have a high risk of recurrence. Larger basilar artery diameter or diffuse intracranial dolichoectasia may increase the risk of recurrence.

Intracranial dolichoectasia in patients with symptomatic intracranial atherosclerotic disease: Results from the MYRIAD study

“…Several observational studies have documented poor prognosis among patients with IDE and stroke 30–34 . A recent observational study of patients with vertebrobasilar IDE and ischemic stroke reported a stroke recurrence risk of 19% during 22 months of follow‐up (10% annual risk) 35 . Contrarily, two clinical trials found that IDE was not associated with stroke recurrence risk in patients with minor noncardioembolic stroke and lacunar strokes, respectively 7,14 .…”

Caliber of Intracranial Arteries as a Marker for Cerebral Small Vessel Disease

“…A previous study suggested extreme brain arterial diameters correlated with vascular death, myocardial infarction, and any vascular event (1). Our previous study also found that a dilated basilar artery correlated with stroke recurrence (2). As the intermediary arteries connect extracranial arteries and cerebral small vessels, intracranial large arteries dampen the systematic pressure and pulsatility that are transmitted to brain capillaries (3).…”

“…Baseline characteristics, vascular risk factors, laboratory data, and medical documents were retrieved. Vascular risk factors, including hypertension (defined as a history of hypertension or diagnosed at discharge), diabetes (defined as a history of diabetes or diagnosed at discharge), hyperlipidemia (defined as a history of hyperlipidemia or received lipid-lowering treatments or diagnosed at discharge), history of myocardial infarction and smoking, were carefully identified according to our previous study (2).…”

“…Diameters of the main seven intracranial arteries ( Figures 1A-C), including the internal carotid arteries (ICA) (R and L) at the intra-cavernous segment, the MCA (R and L) at the M1 segment, the basilar artery (BA) at the mid-pons ( Figures 1D-F) and the intracranial vertebral arteries (VA) (R and L) at the V4 segment, were measured according to our previous study (2). An average arterial Z-score, also named the brain arterial remodeling (BAR) score, for each individual was obtained by adding all measured arteries and dividing by the total number of identified arteries as described in a previous study (1).…”

Absence of pontine perforators in vertebrobasilar dolichoectasia on ultra-high resolution cone-beam computed tomography

“…Chen et al reported that a BA diameter ≥5.3 mm was independently associated with increased 1 36 45 1 1 12 1 1 1 0 1 2 34 40 1 1 3 1 0 0 0 1 3 30 50 1 1 5 1 0 0 0 0 4 33 38 1 1 10 1 0 0 0 0 5 21 43 1 1 stroke recurrence in patients with VBDE on multivariate analysis (HR=4.744; 95% CI, 1.718 to 13.097; p=0.003). 19 This is mainly thought to relate to compromise of basilar perforating arteries, either due to thrombosis or due to their compression or stretching. Initially the anatomic aspects and the large number of perforators were believed to preclude neurointerventional treatment of VBDE.…”