From the Guidelines
Dolichoectasia is a condition characterized by the abnormal enlargement, elongation, and tortuosity of arteries, most commonly affecting the blood vessels at the base of the brain, specifically the vertebrobasilar system, as described in the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack 1.
Definition and Characteristics
Dolichoectasia is associated with traditional ischemic stroke risk factors such as increasing age, hypertension, and male sex, although its relationship to atherosclerotic disease is less clear 1. The condition develops gradually over time due to weakening of the arterial walls, often related to atherosclerosis, hypertension, or congenital factors.
Clinical Presentation
Patients with dolichoectasia may experience various neurological symptoms including headaches, dizziness, visual disturbances, facial pain or numbness, difficulty swallowing, and in some cases, stroke or transient ischemic attacks.
Diagnosis and Treatment
The diagnosis is typically made through imaging studies such as MRI, MRA, CT angiography, or conventional angiography.
- Treatment focuses on managing underlying conditions like hypertension and atherosclerosis, using medications such as antihypertensives and statins.
- In patients with vertebrobasilar dolichoectasia and a history of ischemic stroke or TIA without other attributable causes, the use of antiplatelet or anticoagulant therapy is reasonable for the prevention of recurrent ischemic events, as recommended by the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack 1.
Management Considerations
In severe cases with complications like compression of cranial nerves or risk of rupture, surgical interventions might be considered, though these carry significant risks due to the complex anatomy involved.
From the Research
Definition and Characteristics of Dolichoectasia
- Dolichoectasia is an arterial disease that causes dilatation and/or tortuosity of the affected vessel 2.
- It is characterized by marked elongation, widening, and tortuosity of arteries, with the intracranial vertebral and basilar arteries being preferentially involved 3.
- Dolichoectatic arteries usually have an abnormally large external diameter and a thin arterial wall, with degeneration of the internal elastic lamina, multiple gaps in the internal elastica, thinning of the media secondary to reticular fiber deficiency, and smooth muscle atrophy 3.
Clinical Presentations and Risks
- Dolichoectasia commonly presents with ischemic or hemorrhagic stroke, and/or cranial neuropathies 2.
- The posterior circulation is more frequently affected by the dolichoectatic process than the anterior circulation 2.
- Dolichoectasia is associated with a high risk of mortality and morbidity, with progressive enlargement of arterial size being a predictor of mortality 4.
- Patients with dolichoectasia are also at risk of vascular death, recurrent strokes, compressive symptoms, cardiac ischemic disease, and aortic aneurysms 5.
Diagnosis and Treatment
- A positive diagnosis of dolichoectasia requires visual assessment of vessel shape and, if the posterior circulation is affected, application of Smoker's criteria 2.
- Reproducible criteria that aid diagnosis of dolichoectasia in the anterior circulation are lacking 2.
- There is no specific treatment for dolichoectasia, and the surgical and medical therapies that have been used to treat this condition have not been systematically evaluated 2, 4.
- Therapeutic interventions aimed at slowing down arterial dilatation and preventing thrombosis, such as the use of doxycycline and apixaban, have been proposed, but more evidence is needed to determine their effectiveness 4.