Vertebrobasilar dolichoectasia in patients with cerebrovascular ischemic stroke: does it have a role in cerebral microbleeds?

Abstract

Background Vertebrobasilar dolichoectasia (VBD) may account for cerebral microbleeds (CMBs) in ischemic cerebrovascular stroke. Objectives To examine whether VBD is associated with the involvement of CMBs in any region and, if so, whether it is associated with CMBs among ischemic stroke patients located in posterior circulation territory. For patients with VBD, we also studied ischemic stroke subtypes, and checked whether dolichoectasia was linked to vascular risk factors. Methods Two hundred ischemic stroke patients in whom detailed clinical data and brain MRI sequences were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed. Results The mean age of patients was (65.22 ± 12.88), male patients were more frequent (67.5%); dyslipidemia was the most frequent risk factor (55%). Cardio-embolic stroke subtype was the most frequent (37%) and (71.5%) of patients had no history of previous use of antithrombotic drugs. Ectasia was found in 28 (14%), dolichosis was found in 50 (25%) and vertebrobasilar dolichoectasia was found in 19 (9.5%) of patients. Cerebral microbleeds were detected in 114 (57%) patients. Mild degree CMBs was the most prevalent among patients 69 (61%) and were located predominantly in both anterior and posterior territories 41 (36%). CMBs were significantly more frequent in hypertensive and older patients. Conclusions In patients with VBD, severe degree CMBs were more common and were located as a vascular territory supplied by vessels originating from dolichoectatic parent vessels in the posterior region.

Relationships between intracranial arterial dolichoectasia and small vessel disease in patients with ischaemic stroke: a systematic review and meta-analysis

“…After removing duplicated records using an automation tool (The Systematic Review Accelerator: SRA) [ 27 ], abstract screening, and assessing 17 full texts, we included six case–control and observational cohort studies from seven publications comprising 6102 patients with ischaemic stroke (Fig. 1 ) [ 7 , 12 , 13 , 15 , 28 – 31 ]. Most of the included studies used computed tomography angiography (CTA) or magnetic resonance angiography (MRA) as imaging modalities for diagnosing IADE, however, in a study by Pico et al brain-autopsy was used, while the study of Brutto et al used a semiautomatic vessel calculation method, which IADE was performed using automated software, and used to calculate the vessel diameter, length and tortuosity index (TI) [ 12 , 28 ].…”

“…The degree of basilar artery tortuosity, BA dolichosis, was independently associated with deep CMBs (Odds ratio (OR) 4.14, P = 0.002) [ 32 ]. In patients with VBD, CMBs are more frequently documented in the posterior circulation brain regions, including the cerebellum, thalamus, and occipital lobe [ 43 ] and a high CMBs burden (> 10 CMBs) was more frequent in vascular territories supplied by vessels arising from dolichoectatic vessels in the posterior region [ 31 ]. This anatomical link between large and small artery pathology is consistent with either shared pathophysiological mechanisms or vulnerability rather than simply shared risk factors [ 29 , 31 , 36 , 43 ].…”

“…In patients with VBD, CMBs are more frequently documented in the posterior circulation brain regions, including the cerebellum, thalamus, and occipital lobe [ 43 ] and a high CMBs burden (> 10 CMBs) was more frequent in vascular territories supplied by vessels arising from dolichoectatic vessels in the posterior region [ 31 ]. This anatomical link between large and small artery pathology is consistent with either shared pathophysiological mechanisms or vulnerability rather than simply shared risk factors [ 29 , 31 , 36 , 43 ]. Importantly, results from meta-regression of gender heterogeneity on the influencing of CMBs in AIS patients with IADE showed that gender might not affect the incidence or burden of CMBs, in agreement with previous studies [ 44 , 45 ].…”

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

“…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. Another report described that the incidence was 0.06-5.8%, but it contributes up to 12% cases of stroke.…”

“…Another report described that the incidence was 0.06-5.8%, but it contributes up to 12% cases of stroke. 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%).…”