Basilar Artery Diameter Is an Independent Predictor of Incident Cardiovascular Events

Abstract

In this study, we investigated the association between BA diameter and CSVD and cerebral large-vessel diseases through brain MRI and prospectively investigated the predictive value of BA diameter for subsequent cardiovascular events in patients with atherosclerotic risk factors. Materials and MethodsMaterials and Methods are available in the online-only Supplement.© 2013 American Heart Association, Inc. Objective-Basilar arterial (BA) dolichoectasia is associated with cerebral small-vessel disease and stroke. However, the association between moderate dilation of the BA and cerebral small-vessel disease or subsequent cardiovascular events remains unclear. This study aims to clarify the factors related to BA diameter and to clarify whether the BA diameter is an independent predictor of cardiovascular events. Approach and Results-The study subjects comprised 493 outpatients with atherosclerotic risk factors. BA diameter, lacunar infarct, severity of deep white matter hyperintensities, and intracranial steno-occlusive lesions were assessed with MRI and magnetic resonance angiography. Then, we prospectively evaluated the association between BA diameter and cardiovascular events. The BA diameter ranged from 1.1 to 5.2 mm, and only 0.8% of the patients had dolichoectasia. Male sex, the presence of lacunar infarcts, the severity of deep white matter hyperintensities, the fetal-type variation of the circle of Willis, and intracranial steno-occlusive lesions were independently associated with BA diameter. In the mean follow-up of 6.0 years, 91 patients developed cardiovascular events. BA diameter was independently associated with total cardiovascular events after adjusting for age, sex, and conventional risk factors (hazard ratio, 1.55 per 1 mm increase in BA diameter; P=0.009). Conclusions-Increased BA diameter within the normal range is related to both large-vessel disease and cerebral small-vessel disease, and it could be a new predictor of cardiovascular events. ResultsThe characteristics of the patients are shown in Table 1. The BA diameter ranged from 1.1 to 5.2 mm (median, 2.7 mm), and the distribution is also shown in Table 1. The variables associated with BA diameter in the univariate analysis were male sex, hypertension, smoking habit, history of ischemic heart disease and stroke, and body height. Also, lacunar infarct, severity of periventricular hyperintensities, deep white matter hyperintensities (DWMH), type of variation of the posterior circle of Willis, intracranial stenotic lesion assessed by MRI, and mean maximum intima-media thickness (IMT) and pulsatility index assessed by carotid ultrasound were associated with BA diameter (Table 2). The BA diameter was significantly smaller in the fetal type than in other variant types of the circle of Willis. In the multiple linear regression analysis, male sex, lacunar infarct, severity of DWMH, fetal-type variation, and intracranial stenotic lesion were independently associated with BA diameter (Table 3).In the follow-up study, the mean follow-up period was 6.0 y...

Coronary and Basilar Artery Ectasia Are Associated

“…7 A relationship between IADE and a higher incidence of coronary events has been reported. 3,8 This finding raises the possibility that muscular arteries (such as coronary and basilar arteries) may simultaneously dilate and remodel in several arterial beds. 9 We performed a case-control study to investigate the coexistence of CAE and IADE in a large consecutive autopsy database.…”

Moving Vessel Wall Research Beyond the Plaque

“…Traditional atherosclerotic risk factors (eg, hypertension, age) and consequences (stroke, ischemic heart disease, intracranial large and small vessel disease) were predictive (blue boxes) of basilar artery dilation in the article by Tanaka et al 15 Both vascular risk factors and basilar artery dilation independently predict new cardiovascular events (red arrows and red box), but basilar artery dilation does not independently predict new cerebrovascular events. This implies underlying connections between basilar and coronary disease.…”

“…The study by Tanaka et al 15 reported in this issue of Arteriosclerosis, Thrombosis, and Vascular Biology examines basilar artery dilation as a possible forme fruste of dolichoectasia and demonstrates the importance of this nonatherosclerotic intracranial vessel pathology for systemic vascular risk. In their prospective imaging study, they show that basilar artery dilation at baseline is a significant predictor of future vascular events, especially coronary events.…”

“…Importantly, the risk from basilar artery dilation only begins to accrue after 2 years of follow-up ( Figure 1 in Tanaka et al 15 ), suggesting that basilar dilation is an early marker of future risk. Longitudinal follow-up of patients with basilar artery dilation will be important to detect and prevent incident cardiovascular or cerebrovascular events, and to determine how and why some patients develop dolichoectasia.…”

“…arterial wall research has slowly begun to move beyond the lumen, 16 the article by Tanaka et al 15 is the first step in moving beyond the plaque toward an understanding of the genetic, biochemical, and physiological contributors to the dynamic life of intracranial, coronary, and peripheral vessel walls.…”