DOLICHOECTASIA OF THE INTRACRANIAL-ARTERIES IN PATIENTS WITH FIRST ISCHEMIC STROKE - A POPULATION-BASED STUDY

Objective: The objective of this study was to estimate the frequency o f intracranial arterial dolichoectasia among patients with first ische mic stroke and to compare clinical characteristics, survival, and recu rrence in those with and without the abnormality. Background: Dolichoe ctasia may cause cerebral infarction by thrombosis, embolism, stenosis , or occlusion of deep penetrating arteries. Methods: The chi-square, Fisher's exact, and logrank tests were used to compare clinical charac teristics, survival, and recurrence for patients with and without doli choectasia among the 387 residents of Rochester, MN, who had brain CT or MRI for first cerebral infarction from 1985 through 1989. Results: Twelve patients (3.1%) had dolichoectasia. Patients with dolichoectasi a were more likely to have had stroke fitting a clinical and radiograp hic pattern of lacunar infarction than those without (42% and 17% resp ectively; p = 0.04). Dolichoectasia was detected in the vertebrobasila r system in eight patients (66.7%), in the carotid system in two patie nts (16.7%), and in both circulatory systems in two patients (16.7%). There were no significant differences in the following characteristics among those with and without dolichoectasia: age, sex, hypertension, diabetes, smoking, and preceding transient ischemic attack. Patients w ith dolichoectasia had better survival (relative risk [RR] for death, 0.26; p = 0.04) after first cerebral infarction but higher rates of st roke recurrence (RR, 2.4; p = 0.02). Conclusions: Dolichoectasia is de tected in 3% of patients with first cerebral infarction and is associa ted with better survival but higher rates of stroke recurrence.