Predictors of Clinical Outcome and Mortality in Vertebrobasilar Dolichoectasia Diagnosed by Magnetic Resonance Angiography

Thomas Wolfe, Eroboghene E. Ubogu, Jose Americo M Fernandes Filho, Osama O. Zaidat

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: Vertebrobasilar dolichoectasia (VBD) is a poorly understood vasculopathy. VBD may be associated with an increased likelihood of stroke and all-cause mortality. 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, and consent 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 = .03) with an adjusted odds ratio of 4.4 (95% confidence interval = 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, BA involvement, 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 study may aid in predicting annual risk of stroke recurrence or death in VBD.

Original languageEnglish (US)
Pages (from-to)388-393
Number of pages6
JournalJournal of Stroke and Cerebrovascular Diseases
Volume17
Issue number6
DOIs
StatePublished - Nov 1 2008

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Vertebrobasilar Insufficiency
Magnetic Resonance Angiography
Mortality
Basilar Artery
Stroke
Peripheral Vascular Diseases
Warfarin
African Americans
Nervous System
Diabetes Mellitus
Pathologic Constriction
Multivariate Analysis
Smoking
Odds Ratio
Confidence Intervals
Hypertension
Morbidity
Recurrence

Keywords

  • Magnetic resonance angiography
  • outcome
  • predictors
  • vertebrobasilar dolichoectasia

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of Clinical Outcome and Mortality in Vertebrobasilar Dolichoectasia Diagnosed by Magnetic Resonance Angiography. / Wolfe, Thomas; Ubogu, Eroboghene E.; Fernandes Filho, Jose Americo M; Zaidat, Osama O.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 17, No. 6, 01.11.2008, p. 388-393.

Research output: Contribution to journalArticle

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abstract = "Objective: Vertebrobasilar dolichoectasia (VBD) is a poorly understood vasculopathy. VBD may be associated with an increased likelihood of stroke and all-cause mortality. 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, and consent 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 = .03) with an adjusted odds ratio of 4.4 (95{\%} confidence interval = 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, BA involvement, 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 study may aid in predicting annual risk of stroke recurrence or death in VBD.",
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AU - Zaidat, Osama O.

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N2 - Objective: Vertebrobasilar dolichoectasia (VBD) is a poorly understood vasculopathy. VBD may be associated with an increased likelihood of stroke and all-cause mortality. 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, and consent 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 = .03) with an adjusted odds ratio of 4.4 (95% confidence interval = 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, BA involvement, 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 study may aid in predicting annual risk of stroke recurrence or death in VBD.

AB - Objective: Vertebrobasilar dolichoectasia (VBD) is a poorly understood vasculopathy. VBD may be associated with an increased likelihood of stroke and all-cause mortality. 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, and consent 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 = .03) with an adjusted odds ratio of 4.4 (95% confidence interval = 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, BA involvement, 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 study may aid in predicting annual risk of stroke recurrence or death in VBD.

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