Dolichoectasia - A Posterior Circulation, Large Vessel Vascu | 46041

Journal of Neurology & Neurophysiology

ISSN - 2155-9562


Dolichoectasia - A Posterior Circulation, Large Vessel Vasculopathy with Unique Clinical and Radiologic Features

Michael Hoffmann and Charles Brock

Aim: To determine the frequency and clinicoradiologic features of patients with olichoectasia in large vessel
ischemic cerebrovascular disease in a tertiary referral based stroke population.
Methods: A standardized prospective investigative protocol including brain imaging, angiography and
sonography was applied to all cerebrovascular patients (n=1292). Retrospective analysis was performed in patients
with stroke or transient ischemic attack with radiological features of dolichoectasia. Comparison was made between
large vessel atherosclerotic (LVA) vasculopathies (n=355) and large vessel dolichoectasia (LVDE).
Results: Within the stroke registry, LVDE comprised of 50/1292 (3.9%) with strokes and 10/223 (4.5%)
presented with TIA’s (p=NS). Risk factor comparison between LVA and LVDE was not significant for gender, age,
hypertension, hyperlipidemia, smoking, alcohol excess, ischemic heart disease and diabetes mellitus. Clinical stroke
presentation differed significantly for total anterior circulation (TAC) (p=0.002) and partial anterior circulation (PAC)
(p=-0.001) being more numerous in LVA. In the LVDE group posterior circulation (POC) ischemia was more
numerous (p=<0.0001). Most frequent isolated symptoms in the LVDE group included vertigo (17/60; 28%), ataxia
(13/60; 22%), facial weakness (12/60; 20%), diplopia (6/60; 10%). Quantitative neurological deficit by Canadian
Neurological Scale (CNS) and disability (Rankin) did not differ significantly between LVDE and LVA. Angiographic
abnormalities involved the basilar artery in 47/50 (94%) of the stroke subgroup and 9/10 (90%) of the TIA subgroup
of the LVDE group. Posterior circulation lesions were seen in 33/50 (67%) of LVDE and 64/355 (18%) of LVA
(p=0.0001). During a 7 year follow up period (mean 4.5 years), recurrent stroke or TIA occurred in 10/50 (20%) in
the LVDE as opposed to 8/355 (2.3%) in the LVA group (p=<0.0001). No further sequele occurred in the LVDE
group treated with anticoagulation (n=9/10) as opposed to antiplatelet therapy (1 died of myocardial infarct) in a 2.5
year follow up period.
Conclusion: 1. LVDE differs significantly from LVA disease in terms of posterior circulation symptoms, stroke
syndromes, brain parenchymal and angiographic features. 2. Recurrent stroke or TIA may be more frequent in
LVDE and anticoagulation may be required more often in this subgroup.