Clinical and Imaging Characteristics of Diffuse Intracranial Dolichoectasia

Area of Science:

• Neurology
• Vascular Biology
• Medical Phenotyping

Background:

• Vertebrobasilar dolichoectasia (VBD) can coexist with anterior circulation disease.
• A subset of patients exhibits multivessel intracranial dolichoectasia, suggesting a distinct phenotype.

Purpose of the Study:

• To define and characterize diffuse intracranial dolichoectasia (DID).
• To compare clinical and angiographic features of DID with isolated VBD.

Main Methods:

• Retrospective review of patients with DID and VBD.
• Comparison of demographics, vascular risk factors, aneurysm prevalence, and outcomes.
• DID defined as aneurysmal dilation involving ≥2 intracranial vascular beds.

Main Results:

• Patients with DID were older and had higher rates of abdominal aortic aneurysms, visceral aneurysms, and smoking.
• DID was associated with increased aneurysm growth and rupture.
• Poorer neurological function and higher aneurysm-related death rates were observed in DID patients.

Conclusions:

• Diffuse intracranial dolichoectasia represents a distinct vascular phenotype.
• DID is linked to systemic arteriopathy and has a significantly worse natural history than VBD.
• Associated saccular and abdominal aortic aneurysms highlight a systemic vascular issue.