Abstract W P168: Intracranial Dolichoectasia in Patients with Recent Lacunar Strokes: The SPS3 Trial

Abstract

Background and Purpose: Intracranial arterial dolichoectasia (IADE) is associated with atherothrombotic strokes, but its relationship with lacunar infarcts is less certain. We investigated the prevalence of IADE and associated risk of recurrent stroke and death in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. Methods: Maximum diameter of the intracranial internal carotid artery (ICA), middle cerebral artery (MCA), vertebral artery (VA), and basilar artery (BA) were measured on 2794 MRAs with IADE defined a priori as >7.0 mm for ICA, >4.0 mm for MCA, >4.0 mm for VA, and >4.5 mm for BA. Patient characteristics and outcomes were compared between patients with and without IADE. Results: IADE was present in ≥1 artery in 210 (7.1%) patients, none in ICA, 5 MCA, 163 BA, and 116 VA. Patients with IADE were more often older (65 vs. 63 years; p = 0.01) male (81% vs. 61 %; p <0.001) and had hypertension (82% vs. 74%; p = 0.008), while diabetes (29% vs. 37%; p = 0.01) was more frequent in patients without IADE. White matter hyperintensities (ARWMC score) were more frequent (severe) in patients with IADE (31% vs. 21%, p = 0.001). In multivariable logistic regression analyses, after adjusting for age, assigned treatments, and hypertension, IADE was not predictive of recurrent stroke (OR 1.2, 95% CI 0.8-1.8) or death (OR 1.5, CI 0.94-2.3). In similar analyses, neither BA nor VA diameter as a continuous measure was predictive of recurrent stroke, however, increased BA diameter was predictive of death (OR 1.2 per mm, CI 1.0-1.5, p = 0.04). VA diameter was not. Conclusion: In this large well characterized cohort of lacunar stroke patients, dilatation of BA was independently associated with death but not recurrent stroke, and IADE in other arteries did not predict stroke or death. IAED in lacunar stroke patients seems to be unrelated to the mechanism and severity of small vessel disease.