Background and purpose: Intracranial dolichoectasia is associated with markers of cerebral small vessel disease in older stroke patients. We evaluated whether this holds true for dolichoectasia of the basilar artery in younger stroke patients.
Methods: We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young (<55 years) TIA/stroke patients in whom detailed clinical data and brain MRI were obtained and stroke subtyping with the TOAST classification was performed. MRI analysis was performed by three experienced readers blinded to clinical and demographic data. The tortuosity of the basilar artery (BA) was rated as none, mild (some tortuosity of BA with a deviation from the midline of > 5 mm to ≤ 10mm), moderate (deviation of BA from midline by > 10 mm and / or diameter > 5mm); or severe (tortuosity with impression of brainstem and /or diameter > 10 mm). The maximum BA artery diameter was also directly measured at its maximum on axial MRI scans. Dolichoectasia was defined in this study as a moderate to severe tortuosity of the BA.
Results: Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with increasing age (odds ratio per decade, 1.26, 95% confidence interval 1.09-1.44), male sex (1.96 [1.59-2.42] and hypertension (1.39, [1.13-1.70]). Dolichoectasia was more common in patients with small infarctions (33.9% vs. 29.8% for acute lesions, p=0.065; 29.1% vs. 16.5% for old lesions, p<0.001), infarct location in the brainstem (12.4% vs. 6.9%, p<0.001), and in white matter (27.8% vs. 21.1%, p=0.001). Microbleeds (16.3% vs. 4.7%, p=0.001), higher grades of white matter hyperintensities (p<0.001) and small vessel disease subtype (18.1% vs. 12.4%, overall p for differences in TOAST: p=0.018) were more often present in patients with dolichoectasia.
Conclusion: Dolichoectasia is common and is associated with imaging markers of small vessel disease, as well as brainstem localization of acute and old infarcts in younger patients with TIA and ischemic stroke.