A 9-Year Longitudinal Study of Basilar Artery Diameter

Prevalence of basilar artery dolichoectasia in patients with acute ischemic stroke or transient ischemic attack in a single center of Spain

INTRODUCTION

Basilar artery dolichoectasia (BADE) refers to abnormal enlargement or displacement of the basilar artery (BA). The previously reported prevalence of BADE among patients with stroke is 0.3 to 33.1%, however, it might vary among studied populations. We aim is to determine the prevalence of BADE in patients presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA) in a Stroke Unit in a single center in Spain.

PATIENTS AND METHODS

Patients 50 years old or older presenting with AIS or TIA were eligible for inclusion. Demographic and clinical data were prospectively collected. Two neuroradiologists, blind to each other, assessed BA morphology.

RESULTS

Among 126 patients, 34.1% fulfilled the criteria for BADE (ectasia or dolichosis). BADE was associated with advanced age (p = 0.04). Patients with fetal-type circle of Willis presented smaller BA diameters (2.9 ± 0.1 vs. 3.5 ± 0.1; p < 0.001), whereas patients with lacunar strokes presented a greater diameter than other stroke subtypes (3.8 ± 0.3 mm vs. 3.3 ± 0.1 mm; p = 0.04).

DISCUSSION AND CONCLUSIONS

In this single-center study of patients presenting with AIS or TIA, the prevalence of BADE (ectasia or dolichosis) is high. Further studies focusing on Spaniards should confirm our results.

A 9-Year Longitudinal Study of Basilar Artery Diameter

Background Dilatation of the basilar artery ( BA ) has been recognized as a predictor of cardiovascular events ( CVE s). However, it is unclear if the longitudinal change in BA diameter (Δ BA ) is associated with CVE s. Methods and Results In a cohort of Japanese participants with vascular risk factors in an observational study, we evaluated the relationship of Δ BA to CVE s and the time course of the BA diameter. The short axis of the BA diameter was measured at the midpons level in T2-weighted images. Brain magnetic resonance imaging measurements included cerebral small-vessel disease, lacunars, and white matter hyperintensities. First, 493 patients were analyzed by the time-dependent Cox proportional hazards model to evaluate the association between Δ BA and CVE s, with adjustment for age, sex, vascular risk factors, and magnetic resonance imaging parameters. Second, we assessed the longitudinal Δ BA in 164 patients who underwent long-term follow-up magnetic resonance imaging, by linear regression analysis. In the mean follow-up of 8.7 years, 105 patients developed CVE s. A smaller Δ BA was independently associated with the high incidence of CVE s (hazard ratio, 0.36; 95% CI, 0.16-0.78; P=0.010; n=493). After a mean interval of 9.4 years, the average Δ BA was 0.41±0.46 mm (excluding patients with fetal-type circle of Willis). Progression of BA dilatation was associated with men but inversely associated with initial BA diameter and fetal-type circle of Willis (n=164). Conclusions BA diameter increased over time (excluding the patients with fetal-type circle of Willis), whereas Δ BA was inversely associated with the incidence of CVE s.