Clinicoradiologic features of vertebrobasilar dolichoectasia in stroke patients

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

BACKGROUND

Intracranial arterial dolichoectasia (IADE) is a common arterial finding of dilation, elongation, or both, affecting large intracranial vessels, and associated with vascular risk factors, including hypertension. Associations of IADE with neuroimaging cerebral small vessel disease (CSVD) may be relevant for diagnosis and prognosis in patients with stroke. The study aimed to conduct an updated systematic review and meta-analysis of observational studies to investigate the relationships of IADE with well-defined CSVD markers in patients with ischaemic stroke.

METHODS

We systematically searched PubMed, Embase, and Scopus for studies on IADE in ischaemic stroke patients with fulfilling predefined inclusion criteria. We pooled data to conduct a meta-analysis to compare the prevalence of SVD markers between patients with and without IADE groups using risk ratios (RRs) and 95% confidence intervals (CIs).

RESULTS

From 157 retrieved abstracts, we included six studies from seven publications comprising 6102 patients with ischaemic stroke. The mean age of patients was 52.8 years, and 3691 (60.5%) were male. IADE was diagnosed in 11.4% (95% CI 8.9-13.9) (761) of included patients; 51.8% (3160) had hypertension. Compared to patients without IADE, individuals diagnosed with IADE had a significantly increased prevalence of lacune (RR 1.67, 95% CI 1.36-2.06, P < 0.01, I2 = 0.00%), cerebral microbleeds (CMBs) (RR 2.56, 95% CI 1.53-4.28, P < 0.01, I2 = 84.95%) and white matter hyperintensities (WMHs) (RR 2.17, 95% CI 1.84-2.56, P < 0.01, I2 = 0.00%).

CONCLUSIONS

In patients with ischaemic stroke, IADE is associated with a higher prevalence of CSVD markers, including lacunes, CMBs, and WMHs. Further studies are needed to clarify the mechanisms underlying these associations and their potential relevance for the understanding, diagnosis, and treatment of CSVD.

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

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.

Effects of abnormal vertebral arteries and the circle of Willis on vertebrobasilar dolichoectasia: A multi-scale simulation study

BACKGROUND

Vertebrobasilar dolichoectasia is a rare cerebrovascular disease characterized by obvious extension, dilation and tortuosity of vertebrobasilar artery, and its pathophysiological mechanism is not clear. This study focused on local hemodynamic changes in basilar arteries with typical vertebrobasilar dolichoectasia, together with unbalanced vertebral arteries and abnormal structures of the circle of Willis, through multi-scale modeling.

METHODS

Three-dimensional models of 3 types of vertebrobasilar arteries were constructed from magnetic resonance images. The first type has no vertebrobasilar dolichoectasia, the second type has vertebrobasilar dolichoectasia and balanced vertebral arteries, and the third type has vertebrobasilar dolichoectasia and unbalanced vertebral arteries. A lumped parameter model of the circle of Willis was established and coupled to these three-dimensional models.

FINDINGS

The results showed that unbalanced bilateral vertebral arteries, especially single vertebral artery deletion mutation, might associate with higher wall shear stress on anterior wall of basilar artery in patients with vertebrobasilar dolichoectasia. And unbalanced bilateral vertebral arteries would increase the blood pressure in basilar artery. Meanwhile, missing communicating arteries in the circle of Willis, especially bilateral posterior communicating arteries absences, would significantly increase blood pressure in basilar artery. The unilateral absence of posterior communicating arteries would increase differences in blood flow between the left and right posterior cerebral arteries.

INTERPRETATION

This study provided a multi-scale modeling method and some preliminary results for helping understand the role of hemodynamics in occurrence and development of vertebrobasilar dolichoectasia.

Ischemic stroke with extensive vasculopathy in a patient with neurofibromatosis type 1

Neurofibromatosis type 1 is an autosomal dominant genetic disorder with multisystem manifestations including vascular abnormalities. The condition is also associated with an increased risk of both ischemic and hemorrhagic stroke. Here we report a case of a 60-year-old male with known neurofibromatosis who presented with right sided hemiparesis. Neuroimaging work-up revealed left internal carotid artery dissection and tandem occlusion of the left internal carotid artery and left middle cerebral artery. There was associated territorial ischemic infarction. The patient was found to have extensive intra and extra cranial vasculopathy including gross basilar dolichoectasia and a right-sided cervical internal carotid artery pseudoaneurysm. This case highlights the clinical significance of neurofibromatosis associated vasculopathy which can result in stroke.

Prospects and Dilemmas of Endovascular Treatment for Vertebrobasilar Dolichoectasia

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.

Study on the Correlation between different Levels of Patients with Vertebrobasilar Dolichoectasia and Posterior Circulation Blood Perfusion

OBJECTIVE

This study investigates the differences and changing trend of posterior circulation blood perfusion between different levels of vertebrobasilar dolichoectasia(VBD) patients. The relationship between the deviation of the basilar artery(BA) in different directions and the location of pontine infarction are also investigated.

METHODS

A cohort of 106 patients(74 males and 32 females) who satisfied the diagnostic criteria for VBD were recruited for this study and classified according to the bifurcation height and the deviation position of the BA, as well as the measured blood perfusion value of the pontine, which includes rCBF, rCBV, MTT, and TTP.

RESULTS

Out of the 106 patients, 19 cases were classified as Level 1, 74 cases were classified as Level 2, and 13 cases were classified as Level 3. The different levels between the VBD groups were statistically significant (P<0.05, P<0.01), and it was found that as the level increases, rCBF and rCBV gradually decreased, while MTT and TTP gradually increased. The statistic results of different perfusion parameters were also significant, when pairwise comparisons between Level 1 and Level 3, and Level 2 and Level 3 were performed. However, when comparing Level 1 and Level 2, only the TTP showed significant result. Among 106 patients, 22 cases had brainstem infarction, 13 cases had left brainstem infarction, 8 cases had right brainstem infarction, and 1 case had brainstem infarction on both sides. Brainstem infarction generally occurs on the opposite side of the direction of BA deviation(P<0.05). Regardless of the BA was deviated to the left or right, perfusion analysis showed that there was significant difference in blood perfusion on both sides of the pontine when BA is deviated(P<0.05, P<0.01). The rCBF and rCBV on the contralateral side of deviation were lower than those on the same side, and the MTT and TTP were longer than those on the same side. There were 37 cases with vertebral artery dominance(VAD), 16 cases with left VAD, and 21 cases with right VAD. Statistical analysis showed that BA was more likely to deflect to the opposite side of the dominant artery(P<0.05), and compared with non-VAD, there was no significant difference in pontine blood perfusion (p>0.05).

CONCLUSION

As VBD level increases, rCBF and rCBV will gradually decreases while MTT and TTP showed sign of increasing. The location of brainstem infarction is opposite to the direction of the BA deviation, and BA is more likely to deviate to the opposite side of the dominant artery.

Basilar Artery Dolichosis Increases the Risk of Long-Term Recurrence in Patients With Pontine Infarction: A Prospective Cohort Study

Background and Purpose: Patients with basilar artery (BA) dolichosis are at high risk of acute pontine infarction (API), but the association between BA dolichosis and long–term stroke recurrence has received little attention. We aimed to identify the effect of BA dolichosis on the risk of long–term brainstem infarction recurrence in patients with API.

Methods: In this prospective cohort study, we enrolled 113 patients with API admitted to our department. BA dolichosis was diagnosed by a BA curve length >29.5 mm or bending length (BL) >10 mm on magnetic resonance angiography. The primary outcome was the occurrence of diffusion–weighted imaging (DWI)–confirmed brainstem infarction. The Cox proportional hazard model was used to detect possible predictors of brainstem infarction recurrence.

Results: Among 113 patients with API, 39 (34.5%) patients had BA dolichosis, and DWI–confirmed brainstem infarction recurred in 15 (13.3%) patients with a mean follow–up time of 31.2 months; the estimated 5–year incidence of brainstem infarction recurrence was 23.1% in patients with BA dolichosis, which was significantly higher than the incidence of 8.1% in patients without BA dolichosis. Cox proportional hazard analysis showed that age ≥65 years (hazard ratio (HR) = 3.341, 95% confidence interval (CI): 1.079–10.348, P = 0.036) and BA dolichosis (HR = 3.048, 95% CI: 1.069–8.693, P = 0.037) were significantly associated with a higher risk of brainstem infarction recurrence. In a subgroup analysis stratified by age, the patients aged ≥65 years with BA dolichosis had a higher risk of brainstem infarction recurrence (HR = 7.319, 95% CI: 1.525–35.123, P = 0.013).

Conclusions: This study indicates that BA dolichosis may increase the risk of long–term brainstem infarction recurrence in patients with API, especially in elderly patients, and therefore warrants more attention in clinical practice.

Prevalence and Clinical Correlates of Intracranial Dolichoectasia in Individuals With Ischemic Stroke

[Figure: see text].

High-Resolution Magnetic Resonance Imaging (HR-MRI) Imaging Characteristics of Vertebral Artery Dissection with Negative MR Routine Scan and Hypoperfusion in Arterial Spin Labeling

Background

Unruptured vertebral artery dissection (VAD) that causes ischemic infarction may require anticoagulant therapy or other treatments. However, anticoagulation therapy is not recommended for patients without ischemic infarction. To date, there has been no research on the imaging characteristics of patients with ischemic hypoperfusion that have a negative routine MRI scan.

Material/Methods

Patients with suspected VAD were recruited between June 2015 and June 2020 in order to perform high-resolution magnetic resonance imaging (HR-MRI). In total, 26 patients with negative MRI routine scans that underwent arterial spin labeling (ASL) examination were included in the study. The patients were divided into the hypoperfusion group and normal group based on whether hypoperfusion was found in ASL. The clinical features and HR-MRI features between these 2 groups were analyzed.

Results

There were no statistical differences between the hypoperfusion group and normal group based on the patient’s clinical characteristics (P>0.05). According to imaging characteristics between the 2 groups, the effective lumen index and the vertebrobasilar artery minimum angle were statistically significant (P<0.001). Therefore, a vertebrobasilar artery minimum angle <90° was negatively correlated to the posterior circulation ischemia hypoperfusion, with a correlation coefficient of −0.686. The effective lumen index was also negatively correlated to the posterior circulation ischemia hypoperfusion, with a correlation coefficient of −0.671. However, the location of the dissection and other HR-MRI characteristics were not statistically significant between these 2 groups (P>0.05).

Conclusions

The hypoperfusion of posterior circulation ischemia caused by VAD is related to the effective lumen index, as well as the vertebrobasilar artery minimum angle.

Basilar artery dolichosis is associated with a poor 90-day outcome in acute isolated pontine infarction

Basilar artery (BA) dolichosis is not uncommon in patients with acute isolated pontine infarction. The effect of this abnormal BA geometrical form on the outcomes of pontine infarction has not been closely examined. This study aims to elucidate whether BA dolichosis contributes to a poor 90-day outcome in acute isolated pontine infarction. A total of 101 patients were enrolled with a median age of 65 years. The BA diameter (p = 0.026), basilar artery length (BAL) (p < 0.001), bending length (BL) (p < 0.001) and the proportion of BA bending (p < 0.001) were significantly higher in the BA dolichosis group. A poor outcome was closely associated with the baseline National Institute of Health Stroke Scale (NIHSS) score (p < 0.001), and BL (p = 0.042) as well as the proportions of BA dolichosis (p = 0.007) and BA bending (p = 0.010) in univariate analysis. Multivariate logistic regression analysis determined that BA dolichosis (adjusted OR = 4.724, 95% CI: 1.481~15.071, p = 0.009) and baseline NIHSS score (adjusted OR = 1.805, 95% CI: 1.296~2.513, p < 0.001) were independently associated with a poor outcome at 90 days. In conclusion, BA dolichosis may be a predictor of concern for a poor 90-day outcome in patients with acute isolated pontine infarction.

Target Sign of Third Ventricle in Basilar Dolichoectasia with Multiple Clinical Presentations: A Case Report

Basilar dolichoectasia (BDE) is an uncommon anatomical variant usually detected incidentally or during stroke evaluation. BDE can occasionally become symptomatic and may present with stroke (infarct or hemorrhage), raised intracranial pressure due to obstructive hydrocephalus, or with cranial nerve palsies. We present a unique case of BDE presenting with obstructive hydrocephalus, stroke, and cranial nerve palsy in single patient and propose a radiological sign (target sign of third ventricle), which could aid in imaging diagnosis and further management.

Microsurgical Strategies for the Treatment of Compression Neuropathies Secondary to Vertebrobasilar Dolichoectasia: From Simple Decompression to Sling Transposition

BACKGROUND

Vertebrobasilar artery dolichoectasia may result in neural element compression anywhere along its course within the cervical region, the craniocervical junction or in the posterior fossa. The clinical syndromes most often observed include cranial neuropathy, bulbar dysfunction, myelopathy and cervical radiculopathy. When indicated, the operative techniques utilized to address vertebrobasilar artery dolichoectasia must be individually tailored, can be technically challenging, and have been rarely expounded.

OBJECTIVE

To share selected cases that demonstrate the variety of pathological states caused by vertebrobasilar artery dolichoectasia as well as our experience in managing this condition.

METHODS

Here we review examples of pathological impingement of neural elements compressed by ectasia within the vertebrobasilar arterial system throughout its anatomic course. The surgical techniques we have employed to alleviate the compression, including simple decompression as well as sling-assisted arterial transposition, are described. The evolution and refinement of our transposition technique are detailed.

RESULTS

A wide range of pathological conditions may result from compression of neural structures throughout the course of the vertebrobasilar system. Compression of cervical nerve roots, the spinal cord, brainstem, and cranial nerves can be seen. Microsurgical management may be indicated in selected cases with gratifying results.

CONCLUSION

Pathological compression of neural structures throughout the course of the vertebrobasilar system should be recognized. When indicated, microsurgical decompression must be tailored to the individual symptomology and the unique anatomic relationship in each case with the potential to prevent neurological worsening and, in many cases, improve functional outcome.

Ultrasound Findings Disclose the Mutual Impact of Vertebrobasilar Dolichoectasia and Vertebral Artery Hypoplasia

OBJECTIVES

Vertebrobasilar dolichoectasia (VBD) and vertebral artery hypoplasia (VAH) are known predisposing factors of posterior circulation stokes. These vascular conditions have unique hemodynamic patterns in neuroimaging studies; however, they have been presented as a single entity in some reports. The aim of this retrospective study was to clarify the relationship between these conditions with regard to ultrasound (US) findings.

METHODS

A total of 465 patients with strokes were recruited. Brain magnetic resonance imaging of vertebrobasilar arteries and differences in extracranial side-to-side vertebral artery (VA) flow were recorded by US and compared in groups.

RESULTS

The mean age of the 465 patients ± SD was 67.23 ± 12.13 years; 296 were men. The prevalence of VBD was 13.5% (n = 63), and 10.8% (n = 50) of the patients had coexisting VAH and VBD. These patients also had the highest prevalence of posterior circulation strokes (58% [n = 29]). A cutoff value of 55.65 mL/min and a ratio discrepancy of 5.28 (group median) for the side-to-side extracranial VA flow volume as detected by conventional US were also observed in the patients with both VAH and VBD.

CONCLUSIONS

Our study revealed a higher prevalence of posterior circulation strokes in the patients with both VBD and VAH. Chronic asymmetric hemodynamic shear force in extracranial VAs leading to deformity of the vertebrobasilar system may explain our observations. Accordingly, the blood flow volume and the ratio difference could potentially be used to detect patients at risk of VBD and reduce stroke risk factors.

Clinical and imaging features of vertebrobasilar dolichoectasia combined with posterior circulation infarction: A retrospective case series study

This study aims to analyze the clinical and imaging features of vertebrobasilar dolichoectasia (VBD) combined with posterior circulation infarction, and to explore risk factors for the occurrence of posterior circulation infarction in VBD patients.VBD patients were divided into 2 groups, according to the results of the imaging examination: posterior circulation infarction group and nonposterior circulation infarction group. The demographics, vascular risk factors, imaging, and other clinical data of the VBD patients were collected and retrospectively compared, and the risk factors for the occurrence of posterior circulation infarction in VBD patients were analyzed. The relationship between imaging features of the VBD blood supply artery and the infarct site was also analyzed.A total of 56 VBD patients were included into the analysis. Among these patients, 26 patients had posterior circulation infarction. Infarction occurred in the blood supply area of the posterior cerebral artery in 14 patients. The difference in the height of the basilar artery bifurcation between patients with vertebrobasilar artery blood supply area infarction and patients with posterior cerebral artery supply area infarction was statistically significant. Hypertension and posterior circulation intracranial atherosclerosis were the risk factors for posterior circulation infarction in VBD patients.Elevated basilar artery bifurcation is a risk factor for infarction in the posterior cerebral artery supply area in VBD patients. Posterior circulation infarction in VBD may be the comprehensive result of multiple factors, such as congenital defects of the basilar artery wall, hypertension, and atherosclerotic lesions.

Prognosis of dolichoectasia in non-cardioembolic transient ischemic attack and minor stroke

Objectives This study aimed to estimate the prognosis of dolichoectasia in non-cardioembolic transient ischemic attack (TIA) and minor stroke patients. Methods Data were derived from the imaging subgroup of patients in the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. Dolichoectasia was defined as ectasia (basilar artery diameter >4.5 mm) and dolichosis (either basilar artery bifurcation above the suprasellar cistern or lateral to the margin of the clivus or dorsum sellae). The prognosis included ischemic stroke recurrence and poor functional outcome (modified Rankin scale 2-6) at 12-month follow-up. The association of dolichoectasia with risk factors and prognosis of patients were assessed using multivariable Cox regression models. Results Overall, 1089 patients with magnetic resonance images in the CHANCE trial were included in this subanalysis. A total of 98 (9.0%) patients were detected with dolichoectasia, and 106 (9.7%) patients had a recurrent ischemic stroke at 12 months. Small artery occlusion (SAO) was more prevalent in patients with dolichoectasia compared with those without dolichoectasia (29.6% vs. 22.7%, hazard ratio [HR] 2.87, 95% confidence interval [CI] 1.59-5.17, p < 0.001). However, multivariate analysis showed no association of dolichoectasia with 12-month recurrent stroke (9.2% vs. 9.8%, HR, 1.15; 95%CI, 0.32-4.12; p = 0.83) and poor functional outcome (7.6% vs. 8.4%, odds ratio, 1.22; 95%CI, 0.24-6.08; p = 0.81) in the current subgroup analysis. Conclusions Dolichoectasia was significantly associated with SAO. There was no relationship between dolichoectasia and 12-month prognosis of patients with non-cardioembolic TIA or minor stroke.

Intracranial Arterial Dolichoectasia

An increased diameter (ectasis) and/or long and tortuous course (dolichosis) of at least one cerebral artery define intracranial arterial dolichoectasia (IADE). IADE could be detected incidentally or may give rise to an array of neurological complications including ischemic stroke, intracranial hemorrhage, or compression of surrounding neural structures. The basilar artery is preferentially affected and has been studied in more detail, mainly due to the presence of accepted diagnostic criteria proposed by Smoker and colleagues in 1986 (1). Criteria for the diagnoses of dolichoectasia in other cerebral arteries have been suggested. However, they lack validation across studies. The prevalence of IADE is approximately 0.08–6.5% in the general population, while in patients with stroke, the prevalence ranges from 3 to 17%. Variations among case series depend on the characteristics of the studied population, diagnostic tests used, and diagnostic criteria applied. In rare instances, an underlying hereditary condition, connective tissue disorder, or infection predispose to the development of IADE. However, most cases are sporadic and associated with traditional vascular risk factors including advanced age, male gender, and arterial hypertension. The link between this dilative arteriopathy and other vascular abnormalities, such as abdominal aortic aneurysm, coronary artery ectasia, and cerebral small vessel disease, suggests the underlying diffuse vascular process. Further understanding is needed on the physiopathology of IADE and how to prevent its progression and clinical complications.

Morphological Characteristics of the Vertebrobasilar Arterial System Are Associated with Vertebrobasilar Dolichoectasia

Background

Vertebrobasilar dolichoectasia (VBD) is characterized by abnormal dilation, distortion, and extension of the vertebral artery (VA) and basilar artery (BA). This study investigated whether BA and VA morphological characteristics were factors predicting VBD.

Material/Methods

Individuals aged ≥18 years undergoing contrast-enhanced magnetic resonance angiography (CE-MRA) of the head/neck were enrolled in 2012 at Changhai Hospital, Shanghai. Data concerning cardiovascular risk factors were recorded. Bilateral VA diameter and lateral displacement, BA diameter and lateral displacement, VA confluence displacement, and dominant VA (DVA) presence/absence were determined from CE-MRA. VBD was diagnosed using established criteria. DVA and no-DVA groups were compared. Logistic regression analysis was used to identify variables independently associated with VBD.

Results

Our study included 1153 individuals, of which 614 (53.3%) had DVA. The DVA group had higher mean age, hypertension prevalence (44.6% vs. 37.5%), and VBD prevalence (8.1% vs. 4.5%), and lower smoking prevalence (24.3% vs. 30.6%), than no-DVA patients. Univariate analysis revealed that age, female sex, hypertension, hyperlipidemia, smoking, alcohol consumption, and DVA presence were associated with VBD occurrence. Multivariate analysis showed that age and presence of a DVA were independently associated with VBD.

Conclusions

Age and presence of DVA are independently associated with VBD.

Vertebrobasilar ectasia in patients with lacunar stroke: the secondary prevention of small subcortical strokes trial

BACKGROUND

The clinical implications of vertebrobasilar ectasia (VBE) in patients with cerebral small-artery disease are not well defined. We investigated whether VBE is associated with recurrent stroke, major hemorrhage, and death in a large cohort of patients with recent lacunar stroke.

METHODS

Maximum diameters of the vertebral and basilar arteries were measured by magnetic resonance angiography and computed tomographic angiography in 2621 participants in the Secondary Prevention of Small Subcortical Strokes trial. VBE was defined a priori as basilar artery greater than 4.5 mm and/or vertebral artery greater than 4.0 mm. Patient characteristics and risks of stroke recurrence and mortality during follow-up (median, 3.5 years) were compared between patients with and without VBE.

RESULTS

VBE affecting 1 or more arteries was present in 200 (7.6%) patients. Patient features independently associated with VBE were increasing age, male sex, white race ethnicity, hypertension, and higher baseline diastolic blood pressure. Baseline systolic blood pressure was inversely associated with VBE. After adjustment for other risk factors, VBE was not predictive of recurrent stroke (hazard ratio [HR], 1.3; 95% confidence interval [CI], .85-1.9) or major hemorrhage (HR, 1.5; CI, .94-2.6), but was of death (HR, 1.7; CI, 1.1-2.7).

CONCLUSIONS

In this large well-characterized cohort of patients with recent lacunar stroke, VBE was predictive of death but not of recurrent stroke or major hemorrhage. In these exploratory analyses, the frequency of VBE was directly related to diastolic blood pressure but inversely related to systolic blood pressure.