Dolicoectasia

Predictors of Clinical Outcome and Mortality in Vertebrobasilar Dolichoectasia Diagnosed by Magnetic Resonance Angiography
Thomas Wolfe, MD,* Eroboghene E. Ubogu, MD,† Jose Americo Fernandes-Filho, MD,‡ and Osama O. Zaidat, MD, MS*

Objective: Vertebrobasilar dolichoectasia (VBD) is a poorly understood vasculopathy. VBD may be associated with an increased likelihood of stroke and all-causemortality. The purpose of this study was to establish predictors for clinical outcome in VBD, and better guide therapeutic medical and surgical interventions. Methods: In all, 64 adult VBD cases diagnosed by magnetic resonance angiography were retrospectively identified and prospectively followed up (4-7 years). Inclusion criteria were age 18 years or older, VBD on magnetic resonance angiography, andconsent to participate. Patients with inadequate follow-up data or hemodynamically significant stenosis or occlusion of the posterior circulation were excluded. Univariate and multivariate analyses were performed with predictor modeling in 45 VBD cases. Results: Basilar artery (BA) involvement was independently associated with the transient/fixed posterior circulation dysfunction (P 5.03) with anadjusted odds ratio of 4.4 (95% confidence interval 5 1.2-16.1). A combination of African American ethnicity, diabetes mellitus, peripheral vascular disease, smoking, and BA involvement predicted 31% of posterior circulation dysfunction, resulting in an annual predicted likelihood of stroke of 4.4% to 7.8% in this group. Hypertension, previous anterior and posterior circulation strokes, BAinvolvement, and lack of previous warfarin use predicted mortality in 23% of cases, resulting in an annual likelihood of death of 3.3% to 5.8% in patients with this combination of clinical and radiologic factors. Conclusions: In patients with VBD, BA involvement increases the risk of neurologic morbidity, whereas mortality seems more predicted by classic vascular risk factors than VBD features. This studymay aid in predicting annual risk of stroke recurrence or death in VBD. Key Words: Magnetic resonance angiography— predictors—vertebrobasilar dolichoectasia—outcome. Ó 2008 by National Stroke Association

From the Departments of Neurology at *Medical College of Wisconsin, Milwaukee, †Baylor College of Medicine, Houston, Texas; and ‡University of Nebraska, Omaha. Received February 5, 2008;revision received May 20, 2008; accepted June 9, 2008. Presented in part as an abstract at the 54th Annual Meeting of the American Academy of Neurology, Denver, Colorado, in April 2002. Address correspondence to Osama O Zaidat, MD, MS, Neurology and Neurosurgery, Medical College of Wisconsin/Froedtert Hospital, 9200 W Wisconsin Ave, Milwaukee, WI 53226. E-mail: szaidat@mcw. edu. 1052-3057/$—see frontmatter Ó 2008 by National Stroke Association doi:10.1016/j.jstrokecerebrovasdis.2008.06.006

Vertebrobasilar dolichoectasia (VBD) is an uncommon vasculopathy of unclear origin affecting the arterial wall of vertebral artery (VA) and basilar artery (BA).1 This disease causes arterial elongation and enlargement with subsequent thrombosis, microembolization, and brainstem compression, with or withoutaneurysm formation.1-9 A variety of clinical syndromes have been associated with VBD, including combined brainstem and cranial nerve syndromes,2,4,8,10-12 cervicomedullary junction compression, 4-6,8,13,14 transient or permanent motor deficits,4,5,7,9,13,15 cerebellar dysfunction,5 central sleep apnea,16 hydrocephalus, ischemic stroke,9,14 and subarachnoid hemorrhage.17-19 It is unclear whichvariables are related to clinical outcome, or what pharmacologic agents may modify these outcomes.

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Journal of Stroke and Cerebrovascular Diseases, Vol. 17, No. 6 (November-December), 2008: pp 388-393

VERTEBROBASILAR DOLICHOECTASIA AND OUTCOME PREDICTORS

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The purpose of this study was to elucidate predictors of outcome in VBD cases from a select population cohort as a means of...