Clinical and imaging features of vertebrobasilar dolichoectasia in patients with ischemic stroke： a retrospective case series study

Abstract

Objective To investigate the clinical and imaging features in patients with vertebrobasilar dolichoectasia （VBD） through a comparative study in patients with ischemic stroke with or without VBD. Methods The patients with acute cerebral infarction were divided into either a VBD group or a non-VBD group according to magnetic resonance angiography. The VBD group was further divided into an anterior circulation infarction subgroup and a posterior circulation infarction subgroup. The cardiovascular risk factors, the diameterof basilar artery （BA）, bifurcation height, and horizontal displacement were compared in all groups. Results A total of 269 patients with acute cerebral infarction were included, 28 had VBD, accounting for 10. 41% of the patients with acute cerebral infarction during the same period. The proportion of male patients （78.6% vs. 66. 8% ;χ^2 =4. 392, P =0. 036）, age （70. 38 ± 10. 58 years vs. 62. 86 ± 12. 20 years; t = 2. 870, P = 0. 009）, and the proportion of hypertension （89. 3% vs. 47. 7% ;χ^2 = 17. 367, P = 0. 000） in the VBD group were significantly higher than those in the non-VBD group. The multivariate logistic regression analysis showed that the advanced age （odds ratio [OR] 1.248, 95% confidence interval [CI] 1. 137- 1.371; P= 0.000）, hyperglycemia （OR 1. 599, 95% CI 1. 181 - 2. 164; P = 0. 002）, hypertension （OR 1. 251, 95% CI 1. 020 - 1. 534; P=0. 032） and increased triglyceride level （OR 1. 876, 95% CI 1.021 - 3. 445; P =0. 043） were the independent risk factors for VBD, while female gender （OR 0. 133, 95% CI 0. 024 -0. 735; P =0. 021） was the independent protective factor for VBD. Of the 28 cerebral infarction patients with VBD, 9 had anterior circulation infarction and 19 had posterior circulation infarction. There were significant differences in BA diameter （[5.40 ± 0. 49 ] em vs. [ 6. 00 ± 0. 77 ] cm; t = 2. 046, P - 0. 041 ）, and the proportions of high score in bifurcation height χ^2 =6. 768, P =0. 037） and horizontal displacement χ^2 =5. 241, P =0. 042） between the 2 groups （all P 〈0. 05）. The multivariate logistic regression analysis showed that the BA bifurcation height was an independent risk factor for posterior circulation infarction （OR 1. 347, 95% CI 1. 069 -2. 457; P = 0. 038） in patients with VBD. Conclusions VBD accounted for 10. 41% of the patients with acute cerebral infarction during the same period. Advanced age, hyperglycemia, hypertension and increased triglyceride level were the independent risk factors for VBD. Female gender was the independent protective factors for VBD, and the BA bifm-cation height was an independent risk factor for VBD occurring posterior circulation infarction. Key words: Stroke; Brain Ischemia; Basilar Artery; Vertebral Artery; Vertebrobasilar Insufficiency; Magnetic Resonance Angiography; Risk Factors