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Published on: December 6, 2016
Dolichoectasia and Small Vessel Disease in Young Patients With Transient Ischemic Attack and Stroke
Vincent Thijs1, Ulrike Grittner2, Franz Fazekas2
1From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.). vincent.thijs@florey.edu.au.
Insights
Basilar dolichoectasia is linked to small vessel disease markers in young stroke patients. This finding highlights potential connections between vascular abnormalities and stroke in younger individuals.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Basilar dolichoectasia is a condition involving the widening and elongation of the basilar artery.
- Cerebral small vessel disease (SVD) encompasses a group of disorders affecting the small arteries, arterioles, and capillaries of the brain.
- The relationship between basilar dolichoectasia and SVD markers in younger stroke patients remains incompletely understood.
Purpose of the Study:
- To investigate the association between basilar dolichoectasia and imaging markers of cerebral small vessel disease.
- To explore this association specifically within a cohort of young patients (<55 years) who have experienced transient ischemic attack (TIA) or ischemic stroke.
Main Methods:
- Utilized data from the Stroke in Young Fabry Patients (SIFAP1) study, a prospective, hospital-based screening study.
- Included young TIA/stroke patients (<55 years) with comprehensive clinical data and brain MRI.
- Performed stroke subtyping using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification.
Main Results:
- Basilar dolichoectasia was identified in 13.2% of patients (508/3850).
- Dolichoectasia was associated with older age, male sex, and hypertension.
- Patients with dolichoectasia showed a higher prevalence of small infarcts (acute and old), brainstem infarcts, white matter lesions, microbleeds, and white matter hyperintensities.
Conclusions:
- Basilar dolichoectasia is associated with imaging markers indicative of small vessel disease.
- The study found a link between dolichoectasia and the presence of infarcts in the brainstem.
- These findings are significant for understanding stroke mechanisms in younger patient populations.
Background And Purpose:
We evaluated whether basilar dolichoectasia is associated with markers of cerebral small vessel disease in younger transient ischemic attack and ischemic stroke patients.
Methods:
We used data from the SIFAP1 study (Stroke in Young Fabry Patients), a large prospective, hospital-based, screening study for Fabry disease in young (<55 years) transient ischemic attack/stroke patients in whom detailed clinical data and brain MRI were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed.
Results:
Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with older age (odds ratio per decade, 1.26; 95% confidence interval, 1.09-1.44), male sex (odds ratio, 1.96; 95% confidence interval, 1.59-2.42), and hypertension (odds ratio, 1.39; 95% confidence interval, 1.13-1.70). Dolichoectasia was more common in patients with small infarctions (33.9% versus 29.8% for acute lesions, P=0.065; 29.1% versus 16.5% for old lesions, P<0.001), infarct location in the brain stem (12.4% versus 6.9%, P<0.001), and in white matter (27.8% versus 21.1%, P=0.001). Microbleeds (16.3% versus 4.7%, P=0.001), higher grades of white matter hyperintensities (P<0.001), and small vessel disease subtype (18.1% versus 12.4%, overall P for differences in TOAST (P=0.018) were more often present in patients with dolichoectasia.
Conclusions:
Dolichoectasia is associated with imaging markers of small vessel disease and brain stem localization of acute and old infarcts in younger patients with transient ischemic attack and ischemic stroke.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583.
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