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Del Brutto VJ, Ortiz JG, Biller J. Intracranial Arterial Dolichoectasia. Front Neurol 2017; 8:344. [PMID: 28769872 PMCID: PMC5511833 DOI: 10.3389/fneur.2017.00344] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jorge G Ortiz
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
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Pico F, Labreuche J, Hauw JJ, Seilhean D, Duyckaerts C, Amarenco P. Coronary and Basilar Artery Ectasia Are Associated. Stroke 2016; 47:224-7. [DOI: 10.1161/strokeaha.115.010797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 09/30/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Intracranial artery dolichoectasia (IADE) and coronary artery ectasia have been associated with stroke and myocardial infarction, respectively. Only rarely have cases of coexisting IADE and coronary artery ectasia been reported. We investigated this association in a large consecutive autopsy series.
Methods—
Sixteen stroke patients with IADE were identified among 381 stroke patients and were matched with 16 stroke patients without IADE. The heart and coronary arteries from all patients were examined after a prespecified protocol.
Results—
Coronary artery ectasia was observed in 8 of the stroke patients with IADE, and in none of the stroke patients without IADE (
P
=0.008). The diameters of basilar and right coronary arteries were positively correlated (IADE patients,
r
=0.51;
P
=0.003 and coronary artery ectasia patients,
P
=0.006).
Conclusions—
This autopsy study examining the association of coronary artery ectasia and IADE in stroke patients suggests a common pathogenesis.
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Affiliation(s)
- Fernando Pico
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Julien Labreuche
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Jean-Jacques Hauw
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Danielle Seilhean
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Charles Duyckaerts
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Pierre Amarenco
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
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Pico F, Labreuche J, Amarenco P. Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia. Lancet Neurol 2015. [PMID: 26194931 DOI: 10.1016/s1474-4422(15)00089-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Up to 12% of patients with stroke have intracranial arterial dolichoectasia (IADE) and the basilar artery is affected in 80% of these cases. Diagnostic criteria and prognosis studies of IADE are based on basilar artery diameter, which is a good quantitative marker for the severity of the disease. The pathophysiology is largely unknown, but IADE can be viewed as a common final pathway of arterial wall response or damage in the tunica media due to various mechanisms, such as matrix metalloproteinase dysfunction or muscle cell or elastic fibre injury. No randomised controlled trials have been undertaken in IADE and thus little high-level evidence is available on which to base treatment guidelines. IADE management depends on clinical presentation and disease severity, and includes blood pressure control, antithrombotic treatments, endovascular procedures, and surgery. Further studies are needed to better define IADE in the general population, to establish its prevalence and pathophysiology, to identify subgroups at risk of life-threatening complications, and to offer effective treatment options.
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Affiliation(s)
- Fernando Pico
- Neurology Department and Stroke Centre, Centre Hospitalier de Versailles, Le Chesnay and Université de Versailles Saint-Quentin-en-Yvelines, Île-de-France, France; INSERM Laboratory for Vascular Translational Science, Paris, France
| | - Julien Labreuche
- Department of Neurology and Stroke Centre, Paris, France; AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France
| | - Pierre Amarenco
- INSERM Laboratory for Vascular Translational Science, Paris, France; Department of Neurology and Stroke Centre, Paris, France; AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France.
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Wolters FJ, Rinkel GJE, Vergouwen MDI. Clinical course and treatment of vertebrobasilar dolichoectasia: a systematic review of the literature. Neurol Res 2013; 35:131-7. [DOI: 10.1179/1743132812y.0000000149] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Franciscus J Wolters
- UMC Utrecht Stroke CenterDepartment of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gabriël J E Rinkel
- UMC Utrecht Stroke CenterDepartment of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mervyn D I Vergouwen
- UMC Utrecht Stroke CenterDepartment of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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