Basilar Dolichoarteriopathy and Early Clinical Deterioration in Acute Isolated Pontine Infarction

Early clinical worsening (ECW) in acute isolated pontine infarcts (AIPI) is frequent, associated with poor prognosis, and its predictors have not been adequately clarified. A possible role of dolichoectatic basilar artery (BA) anatomy in ECW in patients with AIPI is herein studied.

In 146 AIPI patients, infarcts were grouped into tegmental, lateral, anterolateral, anteromedial horizontally; and low, mid, mid-up, and upper pontine vertically. BA dolichoectasia was categorized according to Smoker criteria. An additional criteria of BA laterality angle was described. The length between the infarct long-axis and BA cross-sectional center was measured, and named as "branch length (BL)." ECW was defined as any increase in NIHSS.

ECW was seen in 22 (15%) patients. Univariate analysis documented a higher female ratio (22% vs. 10%, P =0.007), higher atrial fibrillation (18% vs. 7%, P =0.067), more common anteromedial infarct location (77% vs. 49%, P =0.025), and Smoker category-3 BA height (32% vs. 10%, P =0.043) in these patients. In anteromedial infarcts, BL was longer (8.3 vs. 6.1 mm, P =0.052), and reaching to significance in those located at mid-up/upper pontine level (1.22 vs. 0.62 mm, P =0.006). BL >4.4 mm showed an acceptable discriminatory capacity for ECW with an AUC of ROC: 0.615 (95% CI: 0.511-0.712). A regression model indicated female sex (β±SE=1.129±0.551, P =0.040), BL (per 4.4 mm, β±SE=1.236±0.614, P =0.044), and BA height-category-3 (β±SE=1.711±0.645, P =0.008) as independent predictors for ECW.

Some features of basilar dolichoarteriopathy, such as the extreme location of the height of the BA tip and the length of the involved perforator in the prepontine cistern, may be predictors of early clinical worsening in acute isolated pontine infarcts.