Basilar Artery Dolichoectasia Research Articles

Prevalence of basilar artery dolichoectasia in patients with acute ischemic stroke or transient ischemic attack in a single center of Spain.

Basilar artery dolichoectasia (BADE) refers to abnormal enlargement or displacement of the basilar artery (BA). The previously reported prevalence of BADE among patients with stroke is 0.3 to 33.1%, however, it might vary among studied populations. We aim is to determine the prevalence of BADE in patients presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA) in a Stroke Unit in a single center in Spain. Patients 50 years old or older presenting with AIS or TIA were eligible for inclusion. Demographic and clinical data were prospectively collected. Two neuroradiologists, blind to each other, assessed BA morphology. Among 126 patients, 34.1% fulfilled the criteria for BADE (ectasia or dolichosis). BADE was associated with advanced age (p = 0.04). Patients with fetal-type circle of Willis presented smaller BA diameters (2.9 ± 0.1 vs. 3.5 ± 0.1; p < 0.001), whereas patients with lacunar strokes presented a greater diameter than other stroke subtypes (3.8 ± 0.3 mm vs. 3.3 ± 0.1 mm; p = 0.04). In this single-center study of patients presenting with AIS or TIA, the prevalence of BADE (ectasia or dolichosis) is high. Further studies focusing on Spaniards should confirm our results.

Effect of Jiawei Tongqiao Huoxue decoction in basilar artery dolichoectasia mice through yes-associated protein/transcriptional co-activator with PDZ-binding motif pathway

Ethnopharmacological relevanceThe Jiawei Tongqiao Huoxue decoction (JTHD), composed of Acorus calamus var. angustatus Besser, Paeonia lactiflora Pall., Conioselinum anthriscoides ‘Chuanxiong’, Prunus persica (L.) Batsch, Ziziphus jujuba Mill., Carthamus tinctorius L., Pueraria montana var. lobata (Willd.) Maesen & S.M.Almeida ex Sanjappa & Predeep, Zingiber officinale Roscoe, Leiurus quinquestriatus, and Moschus berezovskii Flerov, was developed based on Tongqiao Huoxue decoction in Wang Qingren's “Yilin Gaicuo” in the Qing Dynasty. It has the effect of improving not only the blood flow velocity of vertebral and basilar arteries but also the blood flow parameters and wall shear stress. Especially in recent years, the potential efficacy of traditional Chinese medicine (TCM) for the treatment of basilar artery dolichoectasia (BAD) has attracted great attention as there are still no specific remedies for this disease. However, its molecular mechanism has not been elucidated. To identify the potential mechanisms of JTHD will help to intervene BAD and provide a reference for its clinical application. Aim of the studyThis study aims to establish a mouse model of BAD and explore the mechanism of JTHD regulating yes-associated protein/transcriptional co-activator with PDZ-binding motif (YAP/TAZ) pathway for attenuating BAD mice development. Materials and methodsSixty post-modeling C57/BL6 female mice were randomly divided into sham-operated, model, atorvastatin calcium tablet, low-dose JTHD, and high-dose JTHD groups. After 14 days of modeling, the pharmacological intervention was given for 2 months. Then, JTHD was analyzed by liquid chromatography-tandem mass spectrometry (LC-MS). ELISA was utilized to detect the changes in vascular endothelial growth factor (VEGF) and lipoprotein a (Lp-a) in serum. EVG staining was conducted to observe the pathological changes of blood vessels. TUNEL method was employed to detect the apoptosis rate of vascular smooth muscle cells (VSMCs). Micro-CT and ImagePro Plus software were used to observe and calculate the tortuosity index, lengthening index, percentage increase in vessel diameter, and tortuosity of the basilar artery vessels in mice. Western blot analysis was performed to detect the expression levels of YAP and TAZ proteins in the vascular tissues of mice. ResultsMany effective compounds such as choline, tryptophan, and leucine with anti-inflammation and vascular remodeling were identified in the Chinese medicine formula by LC-MS analysis. The serum levels of VEGF in the model mice decreased significantly while the levels of Lp-a increased obviously compared with those in the sham-operated group. The intima-media of the basilar artery wall showed severe disruption of the internal elastic layer, atrophy of the muscular layer, and hyaline changes of the connective tissue. Apoptosis of VSMCs added. Dilatation, elongation, and tortuosity of the basilar artery became notable, and tortuosity index, lengthening index, percentage increase in vessel diameter, and bending angle remarkably improved. The expression levels of YAP and TAZ protein in blood vessels elevated conspicuously (P < 0.05, P < 0.01). JTHD group markedly reduced the lengthening, bending angle, percentage increase in vessel diameter, and tortuosity index of basilar artery compared with the model group after 2 months of pharmacological intervention. The group also decreased the secretion of Lp-a and increased the content of VEGF. It inhibited the destruction of the internal elastic layer, muscular atrophy, and hyaline degeneration of connective tissue in basilar artery wall. The apoptosis of VSMCs was decreased, and the expression levels of YAP and TAZ proteins were abated (P < 0.05, P < 0.01). ConclusionsThe mechanism of inhibition of basilar artery elongation, dilation, and tortuosity by JTHD, which has various anti-BAD effective compound components, may be related to the reduction in VSMCs apoptosis and downregulation of YAP/TAZ pathway expression.

Prevalence and associated factors of basilar artery dolichosis in patients with acute cerebral infarction.

Little attention has been given to the factors associated with basilar artery (BA) dolichosis. This study aims to elucidate the prevalence and associated factors of BA dolichosis in patients with acute cerebral infarction (ACI). We collected the clinical and laboratory data of 719 patients with ACI admitted to our department. Magnetic resonance angiography was used to evaluate the geometric parameters of the BA and intracranial vertebral arteries (VAs). A BA curve length > 29.5 mm or bending length (BL) > 10 mm was identified as BA dolichosis. Univariate and multivariate logistic regression were performed to determine the factors associated with BA dolichosis. Among 719 patients with ACI, 238 (33.1%) demonstrated BA dolichosis, including 226 (31.4%) with simple BA dolichosis and 12 (1.7%) with basilar artery dolichoectasia (BADE). Pearson correlation analyses showed that BA curve length was positively correlated with BL (r = 0.605). Multivariate logistic regression analysis demonstrated that current smoking (OR = 1.50, 95% CI: 1.02-2.21, p = 0.039), diabetes mellitus (OR = 1.66, 95% CI: 1.14-2.41, p = 0.008), BA diameter (OR = 3.04, 95% CI: 2.23-4.13, p < 0.001), BA bending (OR = 4.24, 95% CI: 2.91-6.17, p < 0.001) and BL (OR = 1.45, 95% CI: 1.36-1.55, p < 0.001) were significantly associated with BA dolichosis. This study suggests that BA dolichosis was common in patients with ACI, and the morphological parameters of the vertebrobasilar artery and acquired risk factors (including smoking and diabetes) were risk factors for BA dolichosis.

Basilar artery dolichoectasia presenting as transverse pontine infarction and "nine syndrome".

Basilar artery dolichoectasia presenting as transverse pontine infarction and "nine syndrome".

Transcranial doppler findings in basilar artery dolichoectasia: a case control study

Basilar artery dolichoectasia (BAD) is a disorder characterized by dilatation, elongation and tortuosity of the basilar artery. Transcranial Doppler ultrasound (TCD) is a useful tool that can detect blood flow in intracranial vessels including basilar artery (BA). Few studies have been conducted on blood flow changes in BAD. This study was conducted to evaluate the Doppler parameters in dolichoectatic BA and to assess if there is any difference in TCD findings between stroke and non-stroke BAD patients. A case-control study was conducted on 35 patients diagnosed with BAD (26 male, 9 female) and 35 age- and gender-matched control group (without BAD) at the Middle Euphrates Neuroscience Center, Al-Sader Medical City, Al-Najaf, Iraq. Dolichoectasia was diagnosed on non-enhanced brain CT scan using established imaging criteria according to Dan Deng et al criteria. Doppler flow for control and stroke cases was recorded. The parameters measured on TCD were peak systolic velocity (PSV), end diastolic velocity (EDV) mean blood velocity (MBV), pulsatility index (PI) and resistive index (RI). After logistic regression for adjustment for the significant confounders, there was statistically significant difference in Doppler parameters between both groups including decrease in each of PSV, EDV and MBV while both PI and RI weren’t statistically significant. Among BAD patients, there was statistically significant difference in all TCD parameters between stroke and non-stroke patients (PSV EDV, MBV, PI and RI). BAD was associated with a decrease in flow velocities as measured by TCD. Furthermore, among BAD patients, those with stroke had lower values for all Doppler parameters than non-stroke patients.

Under pressure: pressure-dependent pontine compression by a dolichoectasia basilar artery, a case report

Basilar artery dolichoectasia can lead to ischemic stroke through thrombosis of small perforating vessels of the brainstem. Here we report the case of a patient with transient paramedian pontine syndrome in the setting of a hypertensive crisis, finding a dolichoectasia basilar artery compressing on the ventral surface of the pons. The outcome was near-complete resolution of deficits after blood pressure control. We propose increased basilar artery pulse pressure as a novel mechanism of transient compression of the brainstem by a dolichoectasia artery.

Basilar dolichoectasia with otorhinolaryngological symptoms: A case report

Introduction: Basilar dolicoectasis is an uncommon change,which makes the vessel tortuous and dilated, which can leadto ischemic, hemorrhagic or compressive changes. Objective:The present study is case report of a patient with basilar arterydolicoectasis and otorhinolaryngological symptoms. ClinicalCase: Patient, 53 years old, male, smoker, hypertensive, atrialfibrillation and gout, who after hospitalization due to strokesuffered a complaint of hearing loss, facial paralysis and dizziness.During hospitalization, he was diagnosed with basilarartery dolichoectasia. Conclusion: Basilar artery dolichoectasiais rare, the otorhinolaryngologist should be aware of vascularcauses when evaluating a patient with otoneurological symptoms.The treatment of basilar artery dolichoectasis remainscontroversial.

Abstract P711: Factors Affecting Intracranial Aneurysm Incidence and Phenotypes at Risk of Rupture in Autosomal Dominant Polycystic Kidney Disease

Background: Autosomal dominant polycystic kidney disease (ADPKD) is an autosomal dominant genetic disorder in which cysts of various sizes invade the renal parenchyma. Intracranial aneurysms occur in 8-12% of ADPKD patients, which is approximately 3-4 times the rate of the healthy population. However, research on factors related to aneurysm incidence and rupture in patients with ADPKD is insufficient. Objective: We analyzed the factors associated with risk of aneurysm incidence and phenotype in ADPKD patients. Methods: From the ADPKD registry in the tertiary hospital, we screened patients with cerebral angiography enrolled between January 2007 and May 2017. Then, 926 enrolled patients were classified into three groups according to the intracranial aneurysm incidence and phenotype (multiplicity, size, location): no intracranial aneurysm (Group 1); low-risk intracranial aneurysm (Group 2); high-risk intracranial aneurysm (Group 3). We analyzed the difference of patients’ demographic factors, cardiovascular risk factors, laboratory data, echocardiographic data, and imaging data between groups. Results: The prevalence [C1] of intracranial aneurysm in ADPKD patients was 16.0%. Aneury[C2] sm-positive group (Group 2 and 3, n=148) was significantly older (p&lt;0.001) and had a greater proportion of females (p&lt;0.001) than patients in the aneurysm-negative group (Group 1, n=778). Compared to Group 1, Group 3 was significantly associated with age (odds ratio (OR) 1.027, p=0.007), female sex (OR 3.184, p&lt;0.001), dyslipidemia (OR 0.460, P=0.001), basilar artery dolichoectasia (OR 8.443, p=0.016), and mitral inflow deceleration time (OR 1.005, p=0.039). Conclusion: Factors associated with a high-risk aneurysms were age, sex, dolichoectasia, dyslipidemia, and mitral inflow deceleration time in ADPKD patients. Identification of these factors would help detect high risk aneurysms and manage the aneurysms in ADPKD patients.

Abstract P374: Dolichoectacic Features of Basilar Artery Serve an Imaging Surrogate of Branch Artery Disease in Patients With Pontine Infarcts

Background: The arterial pathology underlying recent small subcortical infarctions (historically known as lacunar stroke) is heterogenous and includes lipohyalinosis, branch artery atherosclerosis or embolism. Although the use of high-resolution imaging studies directed to vessel wall might be helpful in teasing out these different pathologies, more readily available imaging surrogates such as size or spatial characteristics of the ischemic lesion are used for this purpose in clinical practice. Herein, we determined the distribution of dolichoectacic features of basilar artery in patients presenting with pontine penetrator artery stroke with different underlying occlusive pathologies. Methods: The dolichoectacic features of basilar artery were retrospectively evaluated according to Smoker’s criteria (diameter: &gt;4.5 mm, laterality: more lateral to the lateral margin of clivus or dorsum sellae, and height of bifurcation: at least at the level of third ventricular floor) on CT angiography in ischemic stroke patients with a single penetrator artery occlusion in the pons. Patients with basilar artery pathologies such stenosis, dissection, or apparent dolichoectasia were excluded. Ischemic lesions extending to the surface of pontine base on DWI were judged to be secondary to branch artery occlusion, rather than lipohyalinosis. Results: Out of 122 patients, 68 (56%) had at least one feature suggestive of basilar artery dolichoectasia. Patients with lateral deviation of basilar artery were more likely to harbor infarcts extending to pontine surface (69% vs. 50%); no such relationship was identified for other imaging markers of dolichoectasia. After adjustment for age, gender and vascular risk factors, lateral deviation of the basilar artery remained significantly associated with an infarct pattern suggestive of branch artery occlusion (OR=2.8, 95%CI 1.1-7.3; p=0.031). There was also a tendency for ischemic lesions to be located on the ipsilateral side of the lateral deviation (63%; p=0.081). Conclusion: Our findings highlight that lateral displacement of basilar artery, an imaging feature of basilar dolichoectasia, can be used as an additional surrogate marker of branch artery pathology in patients with pontine penetrator artery infarction.

Basilar neuralgia vs. dolichoectasia: A report of three cases

Basilar artery dolichoectasia is a vague term that describe too many normality and abnormalities under one term. Basilar artery occlusion is a rare finding in a healthy patient in his 40s. This case will present the role of basilar neuralgia in forming a basilar artery occlusion which lead to many neurological events that was documented on multiple CT scans. Keywords: Basilar neuralgia; Dolichoectasia; Basilar artery occlusion; Infarctions; CT

Transcranial doppler findings in basilar artery dolichoectasia: a case control study

Basilar artery dolichoectasia (BAD) is a disorder characterized by dilatation, elongation and tortuosity of the basilar artery. Transcranial Doppler ultrasound (TCD) is a useful tool that can detect blood flow in intracranial vessels including basilar artery (BA). Few studies have been conducted on blood flow changes in BAD. This study was conducted to evaluate the Doppler parameters in dolichoectatic BA and to assess if there is any difference in TCD findings between stroke and non-stroke BAD patients. A case-control study was conducted on 35 patients diagnosed with BAD (26 male, 9 female) and 35 age- and gender-matched control group (without BAD) at the Middle Euphrates Neuroscience Center, Al-Sader Medical City, Al-Najaf, Iraq. Dolichoectasia was diagnosed on non-enhanced brain CT scan using established imaging criteria according to Dan Deng et al criteria. Doppler flow for control and stroke cases was recorded. The parameters measured on TCD were peak systolic velocity (PSV), end diastolic velocity (EDV) mean blood velocity (MBV), pulsatility index (PI) and resistive index (RI). After logistic regression for adjustment for the significant confounders, there was statistically significant difference in Doppler parameters between both groups including decrease in each of PSV, EDV and MBV while both PI and RI weren’t statistically significant. Among BAD patients, there was statistically significant difference in all TCD parameters between stroke and non-stroke patients (PSV EDV, MBV, PI and RI). BAD was associated with a decrease in flow velocities as measured by TCD. Furthermore, among BAD patients, those with stroke had lower values for all Doppler parameters than non-stroke patients.

Basilar artery dolichoectasia an unusual and rare cause of secondary trigeminal neuralgia: a clinical report

Objective: Patients with Trigeminal Neuralgia often consults a dentist for relief of their symptoms as the pain seems to be arising from teeth and allied oral structures. Basilar artery Dolichoectasia is an unusual and very rare cause of secondary Trigeminal Neuralgia as it compresses the Trigeminal nerve Root Entry Zone. Case reports: We report three cases of Trigeminal Neuralgia caused by Basilar artery Dolichoectasia compression. The corneal reflex was found absent in all three of the cases along with mild neurological deficits in one case. Multiplanar T1/T2W images through the brain disclosed an aberrant, cirsoid (S-shaped) and torturous Dolichoectasia of basilar artery offending the Trigeminal nerve Root Entry Zone. Discussion: Based on these findings we propose a protocol for general dentist for diagnosis of patients with trigeminal neuralgia and timely exclusion of secondary intracranial causes. Conclusion: General dentists and oral surgeons ought to consider this diagnosis in patients presenting with chronic facial pain especially pain mimicking neuralgia with loss of corneal reflex or other neurosensory deficit on the face along with nighttime pain episodes. Timely and accurate diagnosis and prompt referral to a concerned specialist can have an enormous impact on patient survival rate in such cases. KEYWORDS Basilar artery; Cirsoid dolichoectasia; Corneal reflex; Trigeminal neuralgia.

Dramatical deformation of basilar artery dolichoectasia related to short‐term recurrent stroke

AbstractA 45‐year‐old man presented with an acute pontine infarction with dolichoectasia of the basilar artery. Four days after initiation of antithrombotic therapy, the occurrence of symptomatic subarachnoid hemorrhage was confirmed by brain computed tomography (MRI), with a remarkable shrinkage of dolichoectasia of the basilar artery. Despite the discontinuation of antithrombotic therapy, subsequent multiple ruptures occurred with re‐expanded DBA and the patient died of respiratory insufficiency. Since DBA has an anatomical structural abnormality in a vessel wall, a shape of vessel could dramatically be changed. Because a transformation of DBA diameter could occur in the course of ischemic and hemorrhagic stroke, we need to pay attention to change of DBA diameter.

Arterial Stiffness is Associated with Intracranial Arterial Stenosis other than Dolichoectasia in the General Population.

Aims: The relationship between central arterial stiffness and aging-related intracranial arteriopathy is not well investigated in the general population. In a population-based study, we investigated arterial stiffness in relation to intracranial atherosclerotic stenosis and intracranial arterial dolichoectasia.Methods: This study was a cross-sectional analysis on 1,123 subjects (aged 56.0 ± 9.3 years, 37.9% men) of the population-based Shunyi study in China. Arterial stiffness was assessed by measuring brachial-ankle pulse wave velocity (baPWV). Intracranial atherosclerotic stenosis and intracranial arterial dolichoectasia were evaluated via brain magnetic resonance angiography. Multivariate regression models were constructed to investigate the association between baPWV and intracranial large artery diseases.Results: Increased baPWV was significantly associated with higher prevalence of intracranial atherosclerotic stenosis (odds ratio for the highest quartile of baPWV compared with the lowest quartile, 3.66 [95% confidence interval, 1.57–8.54]), after adjustment for cardiovascular risk factors in multivariate analysis. BaPWV was not associated with the presence of basilar artery dolichoectasia and dilation of basilar artery and internal carotid artery. When the diameters of intracranial arteries were regarded as continuous variables, increased baPWV was inversely related to the internal carotid artery diameter in fully adjusted models (β ± SE, −0.083 ± 0.042, p = 0.047).Conclusions: This population-based study demonstrates that arterial stiffness was more likely associated with intracranial stenotic arteriopathy other than intracranial dilative arteriopathy.

Cerebellar and brainstem infarction secondary to basilar artery dolichoectasia

Cerebellar and brainstem infarction secondary to basilar artery dolichoectasia

Magnetic resonance imaging findings of hemifasial spasm

Hemifacial Spasm (HFS) is irregular, painless, clonic withdrawal of one half of the face. In addition to medical treatment, surgical treatment is applied according to the underlying cause. magnetic resonance imaging (MRI) is essential to show the offending vessel at the origin of HFS and the absence of other causes of nerve compression. Twenty-five patients with HFS (17 female, 8 male) were evaluated in our clinic. The mean age of the patients was 56.4 years (32-78). While MRI of 17 patients was unremarkable, 4 patients had basilar artery dolichoectasia, 2 patients had basilar artery indentation, 1 patient had cerebellopontin tumour and 1 patient had cerebellopontine arachnoid cyst. The patient with cerebellopontin mass lesion had undergone operation and 12 patients were treated with botulinum toxin. Imaging has first to exclude a secondary hemifacial spasm and secondly to search for and characterize the responsible neurovascular conflict, including arterial dolichoectasia or mass lesions.

Abstract TMP52: Basilar Artery Tortuosity and Elongation and Risk of Ischemic Stroke and Death: The Northern Manhattan Study

Background: Basilar artery (BA) dolichoectasia is defined as dilatation, tortuosity, and/or elongation of the basilar artery. Hospital-based studies have demonstrated an association between BA dilatation and risk of death and stroke. We hypothesized that BA tortuosity and elongation increase risk of death and stroke independent of BA dilatation. Methods: We included stroke-free participants in the Northern Manhattan Study, a population-based prospective cohort study, with an available time of flight MRA. BA tortuosity was defined as BA localization lateral to margin of the clivus, and BA elongation as BA tip distal to margin of the sella. BA diameters were obtained with semi-automated in-house software. Primary outcomes were any death and ischemic stroke. Cox proportional hazards models were used to obtain hazards ratios [HR] and 95% confidence intervals [CI] after adjusting for demographics and vascular risks. Results: Participants (N=1032, mean age 70.7 years, 39.5% men, 65.7% Hispanic) were followed on average for 10.4 ± 3.1 years after their MRA. Among these, 97 (9.4%) had BA tortuosity, 294 (28.5%) had BA elongation, and 98 (9.5%) had both tortuosity and elongation. Participants with BA tortuosity were more likely men, and participants with BA elongation were older, more likely women, non-Hispanic white and were more likely hypertensive. There was no association between BA tortuosity (HR 0.89; 95% CI 0.73 – 1.09, P=0.27), BA elongation (HR 1.12; 0.96 – 1.31, P=0.14), or BA dilatation (HR 1.03; 95% CI 0.84 – 1.27, P=0.76) and risk of death. There was an interaction between BA tortuosity and elongation (P for interaction=0.02); BA elongation was associated with an increased risk of death only among those with BA tortuosity (HR 2.06; 1.29 – 3.29; P=0.002). Adjusting for BA dilatation attenuated the association (HR 1.66; 0.99 – 2.81, P=0.05). We found no association between BA tortuosity (HR 0.92; 95% CI 0.77 – 1.10) or elongation (HR 1.07; 95% CI 0.92 – 1.23), or their combination, and ischemic stroke. Conclusion: Stroke-free individuals with both basilar elongation and tortuosity may have a higher risk of death, but not stroke. Further studies of vasculopathy seen in dolichoectasia and its relationship to systemic vascular disease and mortality are warranted.

Cerebral small vessel disease and systemic arteriopathy in intracranial arterial dolichoectasia patients.

To investigate clinical and demographic characteristics of patients with intracranial arterial dolichoectasia (IADE) and describe the possible coexistence of cerebral small vessel disease (SVD) and systemic arteriopathy. From January 2015 to March 2016, all the patients attending an outpatient service for chronic cerebrovascular diseases were screened for suspected IADE. Identified patients underwent a predefined protocol including: brain MR angiography for the diagnosis of IADE; brain MRI with visual rating of SVD features; whole-body CT angiography to assess signs of systemic arteriopathy; and neuropsychological examination. Among the 251 patients screened, IADE was diagnosed in seven (mean age±SD 68.8±7.2years, six males). Hypertension was the most frequent risk factor. All patients had basilar artery dolichoectasia, two also ectasia of a vessel of the anterior circulation. All patients had white matter hyperintensities that were moderate or severe in six, five had at least one lacune, and all had enlarged perivascular spaces. At least one microbleed was detected in six patients. A variable grade of global cortical atrophy was found in six patients. Systemic arterial ectasia was found in all but one patient. Neuropsychological examination showed a multidomain cognitive impairment in five patients. Our study confirms the high prevalence of cerebral SVD in IADE. The involvement of the brain-supplying arteries is probably part of a systemic arteriopathy in IADE patients, thus suggesting the usefulness of assessing the whole arterial tree in clinical practice. Cognitive deterioration signs are frequent in these patients.

Intracranial Arterial Dolichoectasia and Stenosis

Intracranial arterial dolichoectasia (IADE) is a poorly understood arteriopathy compared with intracranial atherosclerotic stenosis (ICAS). We aimed to investigate the risk factors of IADE and ICAS and their relationship with neuroimaging markers of cerebral small vessel disease in a population-based study. This study comprised 1237 participants (aged 57.2±9.4 years, 37.6% men) who underwent brain magnetic resonance imaging and magnetic resonance angiography. IADE was assessed based on basilar artery dolichoectasia (diameter, height of bifurcation, and laterality of basilar artery) and dilation of basilar artery and internal carotid artery (intracranial volume-adjusted diameter ≥2 SD). ICAS was defined as any degree of stenosis in at least 1 intracranial artery. The neuroimaging markers of cerebral small vessel disease, including lacunes, white matter hyperintensities, microbleeds, dilated perivascular spaces, and brain atrophy, were evaluated. Basilar arterial dolichoectasia was observed in 3.6% (45/1237); intracranial arterial dilation in 5.9% (67/1142); and ICAS in 15.7% (194/1237). Older age, higher systolic blood pressure, diabetes mellitus, higher LDL-C (low-density lipoprotein cholesterol) and lower HDL-C (high-density lipoprotein cholesterol) were associated with the presence of ICAS (all P<0.001), whereas only older age was associated with IADE. ICAS was associated with lacunes (odds ratio, 2.91; 95% confidence interval, 1.96-4.34; P<0.001), increased white matter hyperintensities volume (β±SE, 0.54±0.13; P<0.001), and brain atrophy (β±SE, -1.16±0.21; P<0.001), whereas basilar arterial dolichoectasia was mainly associated with dilated perivascular spaces in basal ganglia (odds ratio, 2.20; 95% confidence interval, 1.20-4.02; P=0.01) and, to a lesser extent, associated with lacunes and microbleeds. IADE and ICAS had different risk factor profiles and associated with different imaging phenotypes of cerebral small vessel disease, suggesting different underlying mechanisms.

Abstract WP114: Basilar Artery Dolichoectasia is Associated With Lacunar Stroke and With Neuroimaging Markers of Small Vessel Disease

Introduction: Among patients with ischemic stroke, 3-17% are found to have at least one intracranial dolichoectatic artery. Atherosclerosis was previously thought to most commonly underlie abnormally dilated arteries, but recently the correlation of dolichoectasia with imaging markers of small vessel disease has suggested a shared underlying vascular process. Further clarification of this association is needed. Hypothesis: Basilar artery dolichoectasia is more frequent in patients with lacunar infarctions in comparison to other stroke subtypes. Imaging markers of small vessel disease are associated with basilar artery dolichoectasia. Methods: Among consecutive ischemic stroke admissions to a single medical center over three years, the 100 cases initially classified as lacunar stroke, and a randomly sample of 100 non-lacunar strokes cases were selected. For the present study, only patients with vascular imaging (MRA or CTA) were included resulting in a final cohort of 86 patients in the lacunar stroke group and 92 in the non-lacunar stroke group. Basilar artery ectasia and dolichosis were defined following Smoker’s criteria. MRIs were reviewed for the presence of old lacunar infarcts, deep cerebral microbleeds, enlarged perivascular spaces and moderate-to-severe white matter hyperintensities. These markers were added for estimating the total small vessel disease score ranging from 0 to 4 points. Results: The mean age was 65.5±1.9 years (53.9% men). Basilar artery dolichoectasia was present in 29.1% of patients with lacunar infarctions and in 15.2% of non-lacunar strokes ( p: 0.04). The mean basilar artery diameter was significantly higher in patients with lacunar mechanism of stroke (3.87±1.04 mm versus 3.30 ±0.9 mm, p: 0.0001). Patients with basilar artery dolichoectasia were more likely to have a small vessel disease score of 2 or higher than those without ( p: &lt;0.05). Conclusions: Our results support a stronger link between dilative arteriopathy and small vessel disease than with other stroke subtypes. Basilar artery dolichoectasia and small vessel disease might have common triggers that activate a cascade of events resulting in the pathological changes characteristics of these conditions.