Association of small-vessel disease with dilatative arteriopathy of the brain : Neuropathologic evidence

• Published in: Stroke (1970) 2007-04, Vol.38 (4), p.1197-1202
• Main Authors: PICO, Fernando, LABREUCHE, Julien, SEILHEAN, Danielle, DUYCKAERTS, Charles, HAUW, Jean-Jacques, AMARENCO, Pierre
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Basilar Artery - pathology; Basilar Artery - physiopathology; Biological and medical sciences; Brain Infarction - epidemiology; Brain Infarction - pathology; Brain Infarction - physiopathology; Cerebral Arteries - pathology; Cerebral Arteries - physiopathology; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - pathology; Cerebrovascular Disorders - physiopathology; Comorbidity; Coronary Artery Disease - epidemiology; Coronary Artery Disease - pathology; Coronary Artery Disease - physiopathology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Intracranial Arteriosclerosis - epidemiology; Intracranial Arteriosclerosis - pathology; Intracranial Arteriosclerosis - physiopathology; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Microcirculation - pathology; Microcirculation - physiopathology; Nervous system; Nervous system (semeiology, syndromes); Neurology; Prevalence; Stroke - etiology; Stroke - pathology; Stroke - physiopathology; Ultrasonic investigative techniques; Vascular diseases and vascular malformations of the nervous system; Vertebrobasilar Insufficiency - epidemiology; Vertebrobasilar Insufficiency - pathology; Vertebrobasilar Insufficiency - physiopathology
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000259708.05806.76

Clinical and imaging studies have reported an independent and intriguing association between intracranial arterial dolichoectasia (IADE) and markers of small-vessel disease (SVD) such as lacune(s). We used a large brain-autopsy collection to investigate the relation between IADE and pathologically assessed cerebral SVD. The entire arterial tree from the heart to the intracranial small intracerebral arteries was investigated in 381 consecutive autopsies from patients with stroke. Vascular risk factors, heart status (weight, coronary atherosclerosis, and myocardial infarction), prevalence and severity of atherosclerosis from heart to brain (aortic arch, carotid, vertebral, and intracranial arteries), dolichoectasia, cerebral SVD, and brain tissue lesions (lacune(s), état criblé) were evaluated. Analyses were adjusted for age, sex, and heart weight. Twenty-three (6%) of 381 patients had IADE, affecting mainly the basilar artery, with a median basilar artery diameter of 6 mm (range, 4 to 9 mm). Patients with IADE had a >2-fold increase in the prevalence of basilar artery plaques and ulcerated plaques in the aortic arch (both P=0.006), but there were no associations with coronary or cervical artery plaques. SVD was more frequent in IADE-positive than in IADE-negative patients (45% vs 18%; P=0.004). The adjusted odds ratio was 3.85 (95% confidence interval, 1.56 to 9.52). Cerebral amyloid angiopathy was not observed in IADE-positive patients. Compared with stroke patients without IADE, those with IADE were more likely to have pathologic evidence of cerebral SVD and its consequences, independent of age, arterial hypertension, or diabetes mellitus. IADE and cerebral SVD may have unidentified biologic processes in common.