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The relationship between intracranial arterial dolichoectasia and intracranial atherosclerosis
Kailin Yin1, Sen Liang1, Xiaogang Tang1
1Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Insights
Intracranial arterial dolichoectasia (IADE) is linked to older age, hypertension, and white matter changes in stroke patients. However, IADE was not associated with intracranial atherosclerosis (ICAS).
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Intracranial arterial dolichoectasia (IADE) and intracranial atherosclerosis (ICAS) are cerebrovascular conditions that can lead to stroke.
- Understanding the relationship between IADE and ICAS is crucial for stroke risk stratification and management.
- Previous studies have yielded conflicting results regarding the association between these two conditions.
Purpose of the Study:
- To investigate the relationship between intracranial arterial dolichoectasia (IADE) and intracranial atherosclerosis (ICAS) in patients with acute ischemic stroke.
- To identify clinical and imaging characteristics associated with IADE.
Main Methods:
- Retrospective analysis of 469 acute ischemic stroke patients from the Nanjing Stroke Registry Program.
- Diagnosis of IADE based on MRI/MRA criteria for basilar artery morphology.
- Definition of ICAS as ≥50% diameter reduction in major intracranial arteries on MRA or CTA/DSA.
- Evaluation of white matter changes and lacunar infarcts on MRI.
Main Results:
- IADE was present in 13% of patients and was associated with older age and higher prevalence of hypertension.
- ICAS was associated with older age, hypertension, prior stroke, higher LDL cholesterol, and elevated white blood cell counts.
- No association was found between IADE and extracranial carotid atherosclerosis.
- After adjustment for confounders, IADE was associated with a lower rate of ICAS (OR 0.417).
- Patients with IADE were more likely to have infratentorial stroke lesions, multi-lacunar infarcts, and white matter changes compared to those without IADE.
Conclusions:
- Intracranial arterial dolichoectasia (IADE) is associated with advanced age, hypertension, multi-lacunar infarcts, and white matter changes.
- Contrary to some expectations, IADE was not found to be associated with intracranial atherosclerosis (ICAS) in this cohort.
- The distinct imaging patterns suggest potentially different underlying pathogenetic mechanisms for IADE and ICAS.
Objective:
We aimed to investigate the relationship between intracranial arterial dolichoectasia (IADE) and intracranial atherosclerosis (ICAS).
Methods:
Patients with acute ischemic stroke were screened via the Nanjing Stroke Registry Program. Patients were diagnosed with IADE (diameter, height of bifurcation, and laterality of basilar artery) based on magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) results. Intracranial atherosclerosis was defined as a ≥50 % diameter reduction in internal carotid artery, middle cerebral artery, posterior cerebral artery, or anterior cerebral artery on MRA, computed tomography angiography, or digital subtraction angiography. We also evaluated the presence and degree of white matter changes and lacuna infarctions on MRI.
Results:
Of the 469 enrolled patients, 61 (13 %) had IADE. Patients with IADE were older (64.1 ± 9.9 vs. 59.6 ± 11.4 years, P = 0.004) and had a higher prevalence of hypertension (78.7 % vs. 61.0 %, P = 0.008) than patients without IADE. Patients with ICAS were older (62.6±10.5 vs 58.1±11.6 years, P < 0.001), had higher prevalence of hypertension (72.9 % vs. 55.0 %, P < 0.001) and a previous history of stroke (21.6 % vs. 9.2 %, P < 0.001), had higher levels of serum low-density lipoprotein cholesterol (2.57±0.82 vs. 2.31±0.86mmol/l P = 0.002), and had high counts of white blood cells (7.90±3.29 vs 7.10±2.44, P = 0.004). No association was detected between IADE and extracranial carotid atherosclerosis [odds ratio (OR)=0.618; 95 % confidence interval (CI), 0.280-1.367; P = 0.235]. After adjusting for age, sex, hypertension, and ischemic heart disease, patients with IADE had a lower ICAS rate than that in those without IADE (OR 0.417, 95 % CI, 0.213-0.816, P = 0.011). Unlike patients with ICAS, patients with IADE were more likely to have infratentorial stroke lesions (OR=2.952, 95 % CI, 1.207-7.223, P = 0.018), multi-lacuna (OR=2.142, 95 % CI, 1.158-3.964, P = 0.015), and white matter changes (OR = 2.782; 95 % CI, 1.522-5.085, P = 0.001).
Conclusions:
IADE was associated with advanced age, hypertension, multi-lacuna, and white matter changes but was not associated with ICAS.
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