Why does my patient’s basilar artery continue to grow? A four-year case study of a patient with symptoms of vertebrobasilar dolichoectasia

Zhang, Dao Pei; Peng, Yan; Qian, Kun; Zhao, Min; Zhang, Huai Liang; Yin, Suo

doi:10.1186/s12883-018-1045-0

Cited by 12 publications

(14 citation statements)

References 22 publications

(30 reference statements)

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“…The uncontrolled hypertension and atherosclerosis have been proposed to be the pathogenic factors for the degeneration of vascular wall. And the autoimmune and inflammation mechanisms are also considered to be the risk factors of VBD (13, 14). Therefore, the inflammatory cytokines may accelerate the fracture or destruction of the internal elastic lamina of vessel wall, leading to further artery extension.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, the development of intramural hematoma is also a vital step in the pathological progression of dolichoectasia (17). Thus, vertebrobasilar artery dissection may also contribute to the exacerbation of VBD (13, 18). When the initial artery diameter is larger than 10 mm, alternative treatments like endovascular procedures and antihypertensive therapy should be considered (19).…”

Section: Discussionmentioning

confidence: 99%

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Vertebrobasilar Dolichoectasia and Basilar Artery Dissection Presenting With Trigeminal Neuralgia: A Case Report

2019

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Trigeminal neuralgia secondary to vertebrobasilar dolichoectasia and basilar artery dissection is rare. The authors report the case of a 72-year-old man with a 5-year history of right electrical facial pain identical with trigeminal neuralgia. Finally, magnetic resonance imaging and digital subtraction angiography revealed basilar artery dissection and vertebrobasilar dolichoectasia. The patient underwent partial basilar dissecting aneurysm embolization. The facial pain was relieved immediately after the operation and disappeared completely 6 months later. Three years after surgery, the patient had experienced no recurrence of the right facial pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vertebrobasilar Dolichoectasia and Basilar Artery Dissection Presenting With Trigeminal Neuralgia: A Case Report

2019

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“…Clinically, both conditions contribute to the extent of ischemic strokes and especially posterior circulation strokes in the vertebrobasilar arterial territory . In addition, among patients with unilateral VAH, a trend of both arterial dilatation over the other dominant VA and elongation to the BA has been observed . These studies have also suggested that the dominant VA may be a risk factor for VBD.…”

mentioning

confidence: 95%

“…16,17 In addition, among patients with unilateral VAH, a trend of both arterial dilatation over the other dominant VA and elongation to the BA has been observed. 3,18,19 These studies have also suggested that the dominant VA may be a risk factor for VBD. However, only a few clinical studies have discussed the relationship between VAH and VBD.…”

mentioning

confidence: 99%

Ultrasound Findings Disclose the Mutual Impact of Vertebrobasilar Dolichoectasia and Vertebral Artery Hypoplasia

Chi

Chen

Hsu

et al. 2019

J of Ultrasound Medicine

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Objectives Vertebrobasilar dolichoectasia (VBD) and vertebral artery hypoplasia (VAH) are known predisposing factors of posterior circulation stokes. These vascular conditions have unique hemodynamic patterns in neuroimaging studies; however, they have been presented as a single entity in some reports. The aim of this retrospective study was to clarify the relationship between these conditions with regard to ultrasound (US) findings. Methods A total of 465 patients with strokes were recruited. Brain magnetic resonance imaging of vertebrobasilar arteries and differences in extracranial side‐to‐side vertebral artery (VA) flow were recorded by US and compared in groups. Results The mean age of the 465 patients ± SD was 67.23 ± 12.13 years; 296 were men. The prevalence of VBD was 13.5% (n = 63), and 10.8% (n = 50) of the patients had coexisting VAH and VBD. These patients also had the highest prevalence of posterior circulation strokes (58% [n = 29]). A cutoff value of 55.65 mL/min and a ratio discrepancy of 5.28 (group median) for the side‐to‐side extracranial VA flow volume as detected by conventional US were also observed in the patients with both VAH and VBD. Conclusions Our study revealed a higher prevalence of posterior circulation strokes in the patients with both VBD and VAH. Chronic asymmetric hemodynamic shear force in extracranial VAs leading to deformity of the vertebrobasilar system may explain our observations. Accordingly, the blood flow volume and the ratio difference could potentially be used to detect patients at risk of VBD and reduce stroke risk factors.

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“…Cranial neuropathies include ophthalmoplegia, nystagmus, hemifacial spasm, facial palsy, dizziness, tinnitus, hearing loss, dysarthria, trigeminal neuralgia [20][21][22] and/or diplopia [23]. Cerebrospinal fluid (CSF) flow obstruction and hydrocephalus may occur when the basilar artery impinges on the third ventricle above the sellar diaphragm [25].…”

Section: Introductionmentioning

confidence: 99%

Melittin-loaded Iron Oxide Nanoparticles Prevent Intracranial Arterial Dolichoectasia Development through Inhibition of Macrophage-mediated Inflammation

Vu¹,

Huynh²,

Ryu³

et al. 2021

Int. J. Biol. Sci.

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Rationale: In intracranial arterial dolichoectasia (IADE) development, the feedback loop between inflammatory cytokines and macrophages involves TNF-α and NF-κB signaling pathways and leads to subsequent MMP-9 activation and extracellular matrix (ECM) degeneration. In this proof-of-concept study, melittin-loaded L-arginine-coated iron oxide nanoparticle (MeLioN) was proposed as the protective measure of IADE formation for this macrophage-mediated inflammation and ECM degeneration. Methods: IADE was created in 8-week-old C57BL/6J male mice by inducing hypertension and elastase injection into a basal cistern. Melittin was loaded on the surface of ION as a core-shell structure (hydrodynamic size, 202.4 nm; polydispersity index, 0.158). Treatment of MeLioN (2.5 mg/kg, five doses) started after the IADE induction, and the brain was harvested in the third week. In the healthy control, disease control, and MeLioN-treated group, the morphologic changes of the cerebral arterial wall were measured by diameter, thickness, and ECM composition. The expression level of MMP-9, CD68, MCP-1, TNF-α, and NF-κB was assessed from immunohistochemistry, polymerase chain reaction, and Western blot assay. Results: MeLioN prevented morphologic changes of cerebral arterial wall related to IADE formation by restoring ECM alterations and suppressing MMP-9 expression. MeLioN inhibited MCP-1 expression and reduced CD68-positive macrophage recruitments into cerebral arterial walls. MeLioN blocked TNF-α activation and NF-κB signaling pathway. In the Sylvian cistern, co-localization was found between the CD68-positive macrophage infiltrations and the MeLioN distributions detected on Prussian Blue and T2* gradient-echo MRI, suggesting the role of macrophage harboring MeLioN. Conclusions:The macrophage infiltration into the arterial wall plays a critical role in the MMP-9 secretion. MeLioN, designed for ION-mediated melittin delivery, effectively prevents IADE formation by suppressing macrophage-mediated inflammations and MMP activity. MeLioN can be a promising strategy preventing IADE development in high-risk populations.

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Why does my patient’s basilar artery continue to grow? A four-year case study of a patient with symptoms of vertebrobasilar dolichoectasia

Cited by 12 publications

References 22 publications

Vertebrobasilar Dolichoectasia and Basilar Artery Dissection Presenting With Trigeminal Neuralgia: A Case Report

Vertebrobasilar Dolichoectasia and Basilar Artery Dissection Presenting With Trigeminal Neuralgia: A Case Report

Ultrasound Findings Disclose the Mutual Impact of Vertebrobasilar Dolichoectasia and Vertebral Artery Hypoplasia

Melittin-loaded Iron Oxide Nanoparticles Prevent Intracranial Arterial Dolichoectasia Development through Inhibition of Macrophage-mediated Inflammation

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