Natural history of vertebrobasilar dolichoectasia

Passero SG, Rossi S. Neurology 2008; 70:66-72.

There is a high degree of variability in outcome ranging from benign to malignant. Clinical expression includes compression of cranial nerves or brainstem, obstructive hydrocephalus, ischemic and hemorrhagic stroke. This study of 156 patients followed an average of 11.7 years showed that 93 patients (60 % ) had at least one event; 59 ischemic strokes, 21 hemorrhagic strokes, 31 compressive symptoms, and 2 hydorcephalus. Risk stratification was based on the severity of , diameter, height of bifurcation, nad lateral displacement of the vertebral artery. Progression of VBD was associated with a worse outcome. 43 % of patients did progress.

Detail: the maximum diameter of the BA ranged from 4.6 to 13.4 mm (mean 6.8). 86 % invlved the VA's and 45 % the anterior circulation. Strokes were more likely among patients who were hypertensive and smokes. Of the strokes, 41 % were brainstem, 29 % superficial arterial territory of PCA, 24 % thalamus, 2 % cerebellum, 66 % lacunes, 34 % large artery.

Of 56 patients who presented with ischemic stroke, 50 received antiplatelet drugs and 6 anticoagulation. 54 % had recurent ischemic strokes, and 13 % recurrent hemorrhagic strokes. 73 % of recurrent strokes happened in first five years of followup.

Treatment initially was NOT related to risk of stroke. 42 % of treated patients (n=33) and 34 % of untreated patients (n=26) had one or more ischemic strokes during followup. Death from stroke (40 % of deaths) occurred among patients who first presented with stroke.

The ten year risk of recurrent stroke among patients presenting with stroke was 56 % which compares to the Rochester experience of 29 % (Meissner and Whisnant, Stroke, 1988).