Cardiovascular Risk and Neuroradiological Profiles in Asymptomatic Vertebrobasilar Dolichoectasia

Abstract

Background: Clinicoradiological variability of vertebrobasilar dolichoectasia (VBD) is known. Little is known about cardiovascular disease (CVD) risk and neuroradiological profiles of asymptomatic VBD. Methods: A total of 7,345 adults (5,534 men and 1,811 women) underwent physical checkup (PC) and brain magnetic resonance (MR) studies between 2004 and 2007. Asymptomatic VBD was diagnosed by neurological examination and MR angiography. Neuroradiological features were analyzed in VBD subjects. CVD risk factors were compared between VBD subjects and 5,000 controls matched by sex and age. Results: Ninety-six subjects (85 men and 11 women) had asymptomatic VBD. The detection rate was 1.3% and the male/female ratio 2.5. The mean age ± SD was 60.4 ± 10.6 years (60.0 ± 10.2 in men and 64.0 ± 13.1 in women). As compared to controls, the frequency of hypertension, obesity, smoking, dyslipidemia, diabetes mellitus and a family history of stroke or CVD was increased significantly in VBD subjects. The mean diameter ± SD of the basilar artery (BA) was 4.7 ± 0.2 mm. Only 4 subjects (4%) had a severe degree of elongation and lateral displacement of the BA. Contact of the vertebral artery with the rostral ventrolateral medulla (AMC) was found in 81 subjects: right AMC in 22 subjects and left AMC in 59 subjects. Frequency of hypertension was significantly higher in the left-AMC subjects (57%) than in subjects with right AMC (9%) and no AMC (5%). Other neuroradiological findings revealed small infarcts in 42 subjects, brainstem compression in 4, hydrocephalus in 4 and brain saccular aneurysm in 3. Conclusions: Asymptomatic VBD was detected in 1.3% of the Japanese PC group. Our data indicated male predominance, multiple CVD risk factors, neurovascular hypertension and small infarcts in asymptomatic VBD.

Basilar Artery Diameter Is an Independent Predictor of Incident Cardiovascular Events

“…17,18 The prevalence of BA or intracranial dolichoectasia is 3.1% to 13.9% in patients with ischemic stroke 5,11 and 1.3% in healthy people. 7 In the present study, patients with a BA diameter >4.5 mm made up only 0.8% of the 493 total patients, of whom 24.7% had a history of ischemic stroke. We defined BA diameter as the minor axis of the BA diameter on the axial MRI images because the BA sometimes extends obliquely and is shaped like an ellipse in cross section, which may be a reason for the smaller size of the BA in this study.…”

“…Several studies have shown that dolichoectasia is associated with cerebral small-vessel diseases (CSVDs), such as lacunar infarct, état criblé, and white matter lesions. 5,6 In addition, aging, 5 atherosclerotic risk factors, 5,7 and some genetic factors that affect connective tissues [8][9][10] have been shown to be related to dolichoectasia. Dolichoectasia is most often observed in the basilar artery (BA) 5,11,12 and is associated with intracranial bleeding, stroke mortality, and cardiovascular death.…”

Moving Vessel Wall Research Beyond the Plaque

“…9 Dolichoectasia is strongly associated with aging and vascular risk factors. 10 Rare case reports describe diffuse involvement of all intracranial vessels, 11 and onset in childhood and infancy has been reported, 12 suggesting underlying genetic or congenital causes. This relatively rare vessel anomaly (affecting 1% to 6% of asymptomatic people in scan and autopsy series 10,13,14 ) is linked to vascular risk factors and thus is likely preceded by a more common forme fruste stage of vessel enlargement.…”

Vertebrobasilar artery dolichoectesia and pain; coincidence or etiology ?

“…[4] Vertebrobaziler arter dolikoektazilerinin (VBD) toplumdaki insidansı %0.06-%5.8 arasında rapor edilmektedir. [5][6][7] Olguların büyük çoğunluğu asemptomatiktir ve sıklıkla başka nedenlerle yapılan kraniyel görüntülemelerde, özellikle 40 yaş üzerindeki hipertansif hastalarda, tesadüfen gözlenir. [7] Semptomatik olgulardaki bulgular serebral iskemiye, kanamaya ya da bası etkisine (beyin sapı, üçüncü ventrikül veya kraniyel sinir kökleri) bağlı olarak gelişir.…”

“…[5][6][7] Olguların büyük çoğunluğu asemptomatiktir ve sıklıkla başka nedenlerle yapılan kraniyel görüntülemelerde, özellikle 40 yaş üzerindeki hipertansif hastalarda, tesadüfen gözlenir. [7] Semptomatik olgulardaki bulgular serebral iskemiye, kanamaya ya da bası etkisine (beyin sapı, üçüncü ventrikül veya kraniyel sinir kökleri) bağlı olarak gelişir. VBD'ye bağlı başağrısı olguları oldukça nadirdir ve genellikle tri-PAIN A RI geminal nevralji kliniği ile prezente olurlar.…”