Prospects and Dilemmas of Endovascular Treatment for Vertebrobasilar Dolichoectasia

Abstract

Vertebrobasilar dolichoectasia (VBD) is characterized by significant expansion, elongation, and tortuosity of the basilar artery and vertebral artery. Certain highly selected cases of VBD can require intervention. Recent advances in endovascular treatment (EVT) have renewed hope for patients with VBD. However, which cases of VBD can benefit from EVT still needs to be determined. Currently, little is known regarding this matter. Therefore, we performed a review of the literature from a PubMed search and cataloged our experience regarding the classification and natural history of VBD and the prospects, prognosis and complications of EVT. The findings can be summarized as follows: for asymptomatic VBD, “wait and see” or medical management may be a reasonable strategy. EVT may only be effective in certain patients. For saccular aneurysms in VBD, especially ruptured aneurysms, EVT is reasonable. For fusiform aneurysms in VBD, EVT can carry high complication rates and should be recommended with caution. For stenting reconstruction in VBD, the effect is uncertain. For the future of EVT of VBD, randomized controlled trials and the development of neurointerventional products are worth pursuing, but EVT in VBD still has a long way to go.

Successful endovascular reconstruction of symptomatic vertebrobasilar dolichoectasia using multiple Leo stents and nondominant vertebral artery occlusion: a case report

“…Vertebrobasilar dolichoectasia (VBD) is vascular anomaly of dilation, elongation, increased length, diameter, and/or tortuosity of basilar and vertebral artery. 1 It comprised up to 80% of intracranial arterial dolichoectasia. 2,3 It is discovered incidentally in 1.3-4.4% of general population and symptomatically in 7.6-18.8% of stroke population.…”

“…2,3 While it may be asymptomatic, VBD may manifest in 46.8% subjects as vascular or compressive symptoms, including ischemic stroke, and subarachnoid hemorrhage, cranial nerve compression, brainstem compression, hydrocephalus, cerebellar dysfunction, and central sleep apnea. 1,4 Wolters et al studied 375 VBD subjects and reported that the 5-year new event included ischemic stroke (17.6%), brainstem compression (10.3%), transient ischemic attack (10.1%), spontaneous intracerebral hemorrhage (4.7%), hydrocephalus (3.3%), and subarachnoid hemorrhage (2.6%). Another study by Passero and Rossi (2008) reported that of 156 subjects with VBD and median follow-up of 11.7 years, 43% had progression of VBD and approximately 60% experienced at least one symptomatic event.…”

Studying the imaging features and infarction mechanism of vertebrobasilar dolichoectasia with high‐resolution magnetic resonance imaging

“…Vertebrobasilar dolichoectasia (VBD) is defined as a marked dilation, extension, distortion, or angulation of the vertebrobasilar artery caused by various factors. Its prevalence in patients with stroke ranges from 7.6% to 18.8% [ 1 ]. Ischemic stroke (IS) is the most common clinical manifestation of VBD, followed by progressive compression of the cranial nerves and brainstem, cerebral hemorrhage, and hydrocephalus [ 2 ].…”

Dolichoectasia of the ophthalmic artery: A case report on the treatment strategy in endovascular therapy and literature review

“…One of its causes is the degeneration of the internal elastic lamina caused by arteriosclerosis or other unexplained conditions (1,2). The incidence rate of dolichoectasia is 1.3-4.4%, and the relevant factors of dolichoectasia are atherosclerosis, hypertension, age, smoking, and connective tissue diseases (3)(4)(5). Dolichoectasia is more likely to occur in large vessels such as the vertebrobasilar artery and internal carotid artery (ICA) and is less commonly observed in branch arteries (6,7).…”