Abstract
BackgroundPatients 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.MethodsPatients 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.ResultsA 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.ConclusionsStroke 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.
Highlights
Patients with vertebrobasilar dolichoectasia usually have persistent hemodynamic abnormalities, and may bear an increased risk of stroke
Other baseline demographic and clinical characteristics are delineated in Table 1; 85 (73.9%) patients had hypertension, 38 (33.0%) had diabetes mellitus, and 10 (8.7%) patients had a history of ischemic heart disease (IHD)
We introduced basilar artery (BA) diameters into COX proportionalhazards model as a continuous variable, and found a significant relationship between BA diameter and ischemic stroke (IS) recurrence, the crude hazard ratio (HR) per 1 mm-increase of BA diameter is 1.902
Summary
Patients with vertebrobasilar dolichoectasia usually have persistent hemodynamic abnormalities, and may bear an increased risk of stroke. This study aimed to identify risk factors for stroke recurrence in patients with vertebrobasilar dolichoectasia. In addition to common risk factors such as hypertension, obesity, diabetes mellitus, smoking [4], and ethnicity [5], dolichoectasia of intracranial arteries, which can subsequently lead to intraluminal thrombosis, or perforator vessel occlusion through stretching or squeezing, may increase the risk of stroke recurrence [2]. Previous studies on stroke recurrence in patients with VBD either had relatively small sample sizes [3, 6], did not include patients with dolichoectasia of anterior circulation [2] or lacked evaluation of total arterial geometry abnormalities. We included baseline characters of the patients and in depth descriptions of the arterial geometry, such as dolichoectasia features and arterial stenosis, to help identify the predictive factors for IS recurrence in VBD patients
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