Basilar artery curvature increases the risk of posterior circulation infarction occurrence in patients without vertebrobasilar stenosis.

INTRODUCTION: Limited cross-sectional or case-control studies have identified the relationship between basilar artery (BA) curvature and posterior circulation infarction (PCI). This study aimed to identify the influence of BA curvature severity on the risk of PCI occurrence in patients without vertebrobasilar stenosis through a prospective cohort study. METHODS: In this study, we enrolled 171 patients with BA dolichosis but without vertebrobasilar stenosis. The BA geometric parameters were evaluated on MRA. The primary outcome was the occurrence of PCI, mainly referring to cerebellar and/or brainstem infarction. Cox proportional hazard models were used to detect possible predictors of PCI. RESULTS: Among them, 134 (78.4%) patients were diagnosed with BA curvature, including 124 with moderate curvature and 10 with prominent curvature. The defined PCI occurrence was observed in 32 (18.7%) patients with a median follow-up time of 45.6 months. Cox proportional hazard analysis showed that BA prominent curvature (HR = 6.09; 95% CI: 1.36-27.28; P = 0.018) significantly increased the risk of PCI occurrence, and bending length (BL) was also significantly associated with PCI occurrence, with the adjusted HR per 1-mm increase of BL of 1.09 (95% CI: 1.01-1.18; P = 0.040). In the subgroup analysis stratified by age, BA prominent curvature was highly associated with PCI occurrence in patients aged > 61 years (HR = 11.76; 95% CI: 1.21-113.90; P = 0.033). Additionally, good antiplatelet therapy adherence could significantly reduce the risk of PCI occurrence. CONCLUSION: BA curvature may increase the risk of PCI occurrence, especially in elderly patients with prominent curvature. Improving adherence to antiplatelet therapy can help reduce the risk of PCI occurrence.

Basilar Artery Dolichosis Increases the Risk of Long-Term Recurrence in Patients With Pontine Infarction: A Prospective Cohort Study.

Background and Purpose: Patients with basilar artery (BA) dolichosis are at high risk of acute pontine infarction (API), but the association between BA dolichosis and long-term stroke recurrence has received little attention. We aimed to identify the effect of BA dolichosis on the risk of long-term brainstem infarction recurrence in patients with API. Methods: In this prospective cohort study, we enrolled 113 patients with API admitted to our department. BA dolichosis was diagnosed by a BA curve length >29.5 mm or bending length (BL) >10 mm on magnetic resonance angiography. The primary outcome was the occurrence of diffusion-weighted imaging (DWI)-confirmed brainstem infarction. The Cox proportional hazard model was used to detect possible predictors of brainstem infarction recurrence. Results: Among 113 patients with API, 39 (34.5%) patients had BA dolichosis, and DWI-confirmed brainstem infarction recurred in 15 (13.3%) patients with a mean follow-up time of 31.2 months; the estimated 5-year incidence of brainstem infarction recurrence was 23.1% in patients with BA dolichosis, which was significantly higher than the incidence of 8.1% in patients without BA dolichosis. Cox proportional hazard analysis showed that age ≥65 years (hazard ratio (HR) = 3.341, 95% confidence interval (CI): 1.079-10.348, P = 0.036) and BA dolichosis (HR = 3.048, 95% CI: 1.069-8.693, P = 0.037) were significantly associated with a higher risk of brainstem infarction recurrence. In a subgroup analysis stratified by age, the patients aged ≥65 years with BA dolichosis had a higher risk of brainstem infarction recurrence (HR = 7.319, 95% CI: 1.525-35.123, P = 0.013). Conclusions: This study indicates that BA dolichosis may increase the risk of long-term brainstem infarction recurrence in patients with API, especially in elderly patients, and therefore warrants more attention in clinical practice.

Plaque features and vascular geometry in basilar artery atherosclerosis.

Hemodynamic changes occurring at the segments of arterial bifurcations, up and down stream of stenotic vessels appear to play a critical role in the development of atherosclerosis. Therefore, we hypothesized that basilar artery (BA) geometry may be related to the distribution of atherosclerotic plaque.In this retrospective cross-sectional study, all patients hospitalized with ischemic stroke and intracranial atherosclerotic disease were sifted from March 2017 to October 2017. Sixty-seven patients with intracranial atherosclerotic disease (39 with and 28 without BA atherosclerosis) were analyzed. Magnetic resonance imaging, magnetic resonance angiography, and high-resolution black-blood MRI were performed within 7 days after symptoms onset. BA tortuosity, plaque location, and plaque enhancement were assessed. Plaque burden and vascular remodeling were measured.Of the 39 patients with BA atherosclerosis, plaques preferred to be formed at the inner arc than the outer arc (27/39, 69% vs 12/39, 31%) in the tortuous BA. In addition, patients with BA plaque had a greater vascular tortuosity compared with those without plaque (113.1 ±â€Š10.2 vs 107 ±â€Š4.6; P = .034). Finally, patients with apparent BA plaque had greater plaque enhancement (14/21, 67% vs 5/18, 28%; P = .017) and plaque burden (0.76 ±â€Š0.15 vs 0.70 ±â€Š0.09; P = .036) compared with those with minimal plaque.Plaque may be more likely to form at the inner arc of tortuous BA with atherosclerotic disease, and increased BA tortuosity is associated with its likelihood to form plaque.

Basilar artery dolichosis is associated with a poor 90-day outcome in acute isolated pontine infarction.

Basilar artery (BA) dolichosis is not uncommon in patients with acute isolated pontine infarction. The effect of this abnormal BA geometrical form on the outcomes of pontine infarction has not been closely examined. This study aims to elucidate whether BA dolichosis contributes to a poor 90-day outcome in acute isolated pontine infarction. A total of 101 patients were enrolled with a median age of 65 years. The BA diameter (p = 0.026), basilar artery length (BAL) (p < 0.001), bending length (BL) (p < 0.001) and the proportion of BA bending (p < 0.001) were significantly higher in the BA dolichosis group. A poor outcome was closely associated with the baseline National Institute of Health Stroke Scale (NIHSS) score (p < 0.001), and BL (p = 0.042) as well as the proportions of BA dolichosis (p = 0.007) and BA bending (p = 0.010) in univariate analysis. Multivariate logistic regression analysis determined that BA dolichosis (adjusted OR = 4.724, 95% CI: 1.481~15.071, p = 0.009) and baseline NIHSS score (adjusted OR = 1.805, 95% CI: 1.296~2.513, p < 0.001) were independently associated with a poor outcome at 90 days. In conclusion, BA dolichosis may be a predictor of concern for a poor 90-day outcome in patients with acute isolated pontine infarction.