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

Abstract

The mechanisms underlying ischemic infarction in patients with vertebrobasilar dolichoectasia (VBD) remain unclear. In this study, we retrospectively analyzed the imaging characteristics of high‐resolution magnetic resonance imaging (HR‐MRI) in patients with VBD to explore the possible mechanisms of ischemic stroke (IS) in patients with VBD. Patients with VBD were recruited from the HR‐MRI database between July 2017 and June 2021. HR‐MRI was used to evaluate the diameter, bifurcation height, laterality, arterial dissection, and atherosclerotic plaques of the basilar artery (BA). Transcranial Doppler was used to measure the vertebrobasilar mean velocity (Vm), peak systolic velocity (Vs), end‐diastolic velocity (Vd), and pulsatile index. Twenty‐six patients with VBD were enrolled, of which 15 had IS and 11 did not. The incidence of classical vascular risk factors, including age, sex, hypertension, diabetes, and hypercholesterolemia, did not differ significantly between the two groups. The BA diameters of the stroke group were significantly higher than that of the nonstroke group (6.57 ± 1.00 mm vs. 5.06 ± 0.50 mm, p = 0.000). The height of the BA bifurcation in the stroke and nonstroke groups was statistically significant (p = 0.002). Compared with the nonstroke group, the Vm, Vs, and Vd of the BA in the stroke group were lower, but the difference was not significant. In the 16 patients with atherosclerotic stenosis, 30 atherosclerotic plaques were found in the BA, 18 (60%) in the greater curvature, and 12 (40%) in the lesser curvature. In addition, one artery dissection (on the lesser curvature) and two dissecting aneurysms (on the greater curvature) were found in the BA of three patients, respectively. The BA diameter and bifurcation height are factors related to IS in patients with VBD. The mechanism of stroke in patients with VBD may involve abnormal hemodynamics, artery dissection, and atherosclerosis. HR‐MRI is a useful method for evaluating the risk and underlying mechanism of stroke in patients with VBD.

Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques

“…Vertebrobasilar dolichoectasia is characterized by pronounced dilatation, extension, tortuosity, or angulation of the vertebrobasilar artery, attributed to a range of diverse factors (137). Its pathogenesis is multifactorial, encompassing atherosclerosis, hypertension, developmental anomalies, and additional elements including infection (138).…”

“…An augmentation in both the mean diameter and bifurcation height of the BA is firmly linked to the likelihood of a stroke occurrence. Excessive bifurcation angles tend to impose pulling and twisting forces on the perforating arteries of the BA, resulting in diminished blood flow (137,140). Meanwhile, the widening of the BA diameter leads to a noteworthy reduction in blood flow velocity, thereby fostering the development of microemboli and subsequent lipid deposition.…”

Progress in stratified stroke characterization—associated with better diagnosis, accurate prognosis and improved treatment strategies

“…Mortality rates are high due to the non‐specific symptoms and delay in diagnosis. Here, Tao et al (2023), used high‐resolution MRI (HR‐MRI), to fully characterise the arterial structure and function in 24 patients and concluded that risk of stroke was associated with bifurcation height and arterial turbulence and inferior diameters [ 10 ]. This work should help to enable more effective stratified risk assessment following larger‐scale clinical studies.…”

Acute Basilar Artery Occlusion Induced by Rapidly Progressive Thrombosis in Vertebrobasilar Dolichoectasia

“…Vertebrobasilar dolichoectasia is a progressive and complex cerebral artery disease characterized by abnormal elongation, dilation, and distortion of vertebrobasilar arteries of unknown pathogenesis. 1,2 Thrombus in vertebrobasilar dolichoectasia may consist of both fresh and old components, and the extension can occur within hours, requiring a more aggressive management. Acute thrombosis can be treated with intravenous thrombolysis or thrombectomy for occlusive thrombus, but the efficacy remains uncertain.…”