ABSTRACT
OBJECTIVE: The long-term prognosis of patients with vertebrobasilar dolichoectasia (VBD) is unknown. The purpose of this study was to explore the natural history of VBD, evaluate its progression, and examine factors that may influence the clinical course of this condition. METHODS: We conducted a prospective clinical and imaging follow-up study of 156 consecutive patients with VDB followed for an average of 11.7 years. Predictors of events were evaluated by multivariate analysis. Survival analysis was used to evaluate rates of incidence. RESULTS: During follow-up, 93 patients (60%) experienced at least one event: 75 patients had stroke (59 ischemic and 21 hemorrhagic), 31 patients had new compressive symptoms, and 2 patients had hydrocephalus. Events were significantly associated with the severity of VBD, i.e., diameter, height of bifurcation, and lateral displacement of the basilar artery. During follow-up VBD progressed in 43% of patients. Progression of VBD was associated with a higher morbidity and mortality. The cumulative proportion of survivors free of adverse health event was 54.1 at 5 years, 39.5 at 10 years, and 23.5 at 15 years. During follow-up, 62 patients died and stroke was the most common cause of death. CONCLUSIONS: The long-term prognosis of patients with vertebrobasilar dolichoectasia (VBD) depended mainly on the severity of the condition at diagnosis and on its evolutionary characteristics. Progression of VBD exposed patients to high risk of adverse events, especially stroke.
Subject(s)
Vertebrobasilar Insufficiency/complications , Vertebrobasilar Insufficiency/epidemiology , Basilar Artery/diagnostic imaging , Cerebral Infarction/etiology , Cerebral Infarction/pathology , Cerebrovascular Disorders/classification , Cerebrovascular Disorders/etiology , Chi-Square Distribution , Evaluation Studies as Topic , Humans , Longitudinal Studies , Magnetic Resonance Angiography/methods , Magnetic Resonance Imaging/methods , Predictive Value of Tests , Prognosis , Radiography , Survival Analysis , Vertebrobasilar Insufficiency/mortalityABSTRACT
BACKGROUND AND PURPOSE: Intracranial bleeding in patients with vertebrobasilar dolichoectasia (VBD) is considered uncommon, but there are no precise data to support this opinion. The purpose of this study was to examine the incidence and characteristics of intracranial hemorrhage in patients with VBD and to evaluate factors that may promote bleeding. METHODS: We conducted a prospective study of 156 consecutive VDB patients followed-up for an average 9.35 years. The association of demographic, clinical, and imaging features with occurrence of intracranial bleeding was evaluated by multivariate analysis. Survival analysis was used to evaluate rates of incidence. RESULTS: 32 hemorrhagic strokes were observed in 28 patients either as a diagnostic event (n=10) or during follow-up (n=22). Of the 32 hemorrhagic events, 6 were subarachnoid hemorrhage and 26 intraparenchymal hemorrhage. Multivariate analysis found an association between intracranial bleeding and maximum diameter of the basilar artery (OR, 4.29; P=0.009), degree of lateral displacement of the basilar artery (OR, 4.53; P=0.004), hypertension (OR, 4.74; P=0.024), use of antiplatelet or anticoagulant agents (OR, 3.07; P=0.033), and female sex (OR 6.33; P=0.001). The cumulative proportion of survivors free of hemorrhagic stroke was 88.6 at 5 years and 84.4 at 10 years. CONCLUSIONS: Our study showed that intracranial bleeding in patients with VBD is not as uncommon as usually believed. Its occurrence is associated with the degree of ectasia and elongation of the basilar artery and may be favored by hypertension and use of antiplatelet or anticoagulant agents.
