Hemodynamic Consequences of Brain Arterial Dilation in Patients with Dolichoectasia-related Stroke
Lauren Tierney1, Sebastian Vargas-George1, Angelica Morales1, Jorge Lombardi2, Yosdely Cabrera1, Tatjana Rundek1, Jose Gutierrez1, Sebastian Koch1, Jose Romano1, Victor Del Brutto1
1Neurology Department, University of Miami Miller School of Medicine, 2Neurology Department, Cleveland Clinic Florida
Objective:
Evaluate the relationship between arterial dilation and blood flow velocities measured by transcranial Doppler (TCD) in DE-related stroke patients.
Background:
The abnormal enlargement of intracranial arteries, known as dolichoectasia (DE), is a recognized cause of both thromboembolic (TEMB) and small-vessel occlusive ischemic stroke. However, hemodynamic alterations linking DE to ischemic mechanisms remain uncharacterized.
Design/Methods:
Consecutive ischemic stroke patients (August 2024–July 2025) were screened for DE of the intracranial carotid, middle cerebral, and basilar arteries. DE-related stroke was defined as an acute infarct within the territory of a dolichoectatic artery (diameter ≥2 SD above sex-specific means) without an alternative stroke etiology. Ischemic stroke pattern was defined by brain imaging and analysis included only those with TCD available. Diameters and mean flow velocities (MFV) were standardized for comparison; abnormally low MFV was defined as <2 SD below population means. Associations between diameters and MFV were analyzed using regression models adjusted for age, sex, height, hemoglobin, and mean arterial pressure at TCD time.
Results:
Of 494 ischemic stroke cases, 59 (11.9%) were suspected to be DE-related, with 31 meeting inclusion criteria (mean age 68.6 ±11.1 years; 48.4% men, 54.8% TEMB), yielding 144 arteries for analysis. Overall, arterial diameters and MFV mean z-scores were 2.2 ±1.4 and –1.2 ±1.1, respectively, showing an independent inverse association (β −0.25; 95%CI −0.37-−0.13). Individuals with TEMB ischemic pattern had larger diameters (aOR 1.44; 95%CI 1.06-1.95) and lower MFV (aOR 0.67; 95%CI 0.45-0.98) compared to non-TEMB strokes. Symptomatic arteries with TEMB ischemic pattern were more likely to have abnormally low MFV (68.8% vs 14.3%; aOR 8.84; 95% CI 1.10–70.98).
Conclusions:
Arterial enlargement in DE is associated with low-flow hemodynamics, particularly in TEMB strokes, suggesting DE promotes intraluminal thrombosis by flow stagnation. TCD-derived velocities may serve to grade DE severity and potentially guide prognosis and therapy.
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