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 evaluate ischemic 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.

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 ).…”

“…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 ). The BAR score was normalized and then used both continuously and categorically, using three categories: ( 1 ) “individuals with large diameters” for participants with a BAR score>1 SD, ( 2 ) “individuals with small diameters” for participants with a BAR score < -1 SD, and ( 3 ) “individuals with average diameters” for participants with a BAR score between −1 and 1 SD. Within each individual, the greater the number of arteries with negative scores, the more likely it was that the BAR score had a negative overall Z -score and vice versa ( Figure 1G ).…”

Dolichoectasia of vertebrobasilar arteries leading to vascular dementia: A case report

“…Of the patients who present first with brain infarction, 10% are found to have intracranial arterial dolichoectasia (66.7% involving VBD) (6). There is a high risk of recurrence of stroke when associated with VBD, and the risk is proportionate to the diameter of the vertebra basilar artery (7).…”