Supplementary Table 1│Patient characteristics of selected studies of dolichoectasia
Study
Kwon et al.
(2009)1
Study design (population number)
Prospective study of patients with isolated
pontine stroke without vertebrobasilar
stenosis or embolic sources at Seoul
National University Boramae Hospital (96)
Retrospective review of the Multiple
Atherosclerosis Site in Stroke autopsy
database of patients seen at La Salpetriere
Hospital, France who died of neurological
disease (381)
Diagnostic methods
Smoker’s criteria applied
to MRI
Study period
2002–2007
Visual inspection of BA
diameter
1982–1989
Passsero et
al. (2005)3*
Prospective cohort study of patients seen in
the Department of Neurology, Neurosurgery
or Otorhinolaryngology of the University of
Sienna, Italy who were screened for
vertebrobasilar dolichoectasia; average
patient follow-up 9.35 years (156)
Smoker’s criteria applied
to ICA, MCA and VA
1980–2003
Not applicable
Flemming et
al. (2004)4*
A retrospective hospital-based cohort study
of Mayo Clinic (Rochester, MN, USA)
patients with radiographically based
diagnosis of dolichoectasia, fusiform
aneurysm or enlarged or tortuous VA or BA
(159)
Visual assessment by the
radiologist
1989–2001
Not applicable
Ubogu et al.
(2004)5*
A retrospective review of all MRI and
MRAs performed at Duke University
Medical Center, Durham, NC, USA (1,440)
Smoker’s criteria—
anatomical landmarks
applied to MRA source
images
1995–1997
Pico et al.
(2007)2
1
Prevalence (%)
18.7
6.0
4.4
Sample characteristics (%)
Not applicable
Not applicable
Age (years)
Male sex
Hypertension
DM
Smoking
Dyslipidemia
MI
Age (years)
Male sex
Hypertension
DM
Smoking
CAD or MI
Dyslipidemia
Alcohol abuse
Age (years)
Male sex
Hypertension
DM
Smoking
CAD or MI
Dyslipidemia
PAD
Family history‡
Age(years)
Male sex
Hypertension
DM
Smoking
CAD or MI
Dyslipidemia
Family history‡
78.0
52.0
65.0
0.0
4.4
7.4
44.0
60.5
75.0
64.0
37.0
28.0
10.0
28.0
10.0
64.8
74.0
69.0
10.0
52.0
28.0
40.0
7.0
9.0
73.4
29.0
71.0
18.0
47.0
29.0
31.0
26.0
Pico et al.
(2003)6*
Review of multicenter French database of
patients presenting with stroke; inclusion
criteria were presence of clinical symptoms
of stroke, absence of hemorrhage on brain
CT, presence of brain infarction proven by
MRI, aged 18–85 years and having both
parents of Caucasian origin (510)
Visual inspection—arterial
diameters on MRI;
Smoker’s criteria applied
to MRI
1995–unknown
Nakatomi et
al. (2000)7
Retrospective review of cases with the
diagnosis of fusiform aneurysm seen at
multiple Japanese hospitals (16)
A retrospective review of patients with
stroke and available neurological imaging
taken from Mayo Clinic (Rochester, MN,
USA) city-wide epidemiological database
(387)
Case–control study of patients with stroke
and dolichoectasia compared with patients
with stroke but no dolichoectasia at the
University of Sienna, Italy (40 cases and 40
controls)
Visual inspection
1993–1998
Visual inspection
1985–1989
Smoker’s criteria
Not applicable
Retrospective review of operated fusiform
aneurysms in the posterior and anterior
circulation at the University of Western
Ontario, ON, Canada and Mercy
Neuroscience Institute, Miami, FL, USA
(120)
Retrospective review of patients diagnosed
with dolichoectatic aneurysm who were
treated at Barrow Neurological Institute,
Phoenix, Arizona and University of New
Mexico, Albuquerque, NM, USA
demographic and clinical variables were
analyzed (40)
Case series of patients with dolichoectasia
collected during a 6 year period at
University of Heidelberg and University of
Dusseldorf, Germany (45)
Visual inspection
1965–1992
Visual inspection
1986–1994
Smoker’s criteria—arterial
diameters (as per Yu et al.)
Not applicable
Ince et al.
(1998)8
Passero et al.
(1998)9
Drake et al.
(1997)10
Anson et al.
(1996)11
Rautenberg
et al.
(1992)12
2
12.0
Age(years)
Male sex
Hypertension
DM
Smoking
CAD or MI
70.5
79.0
76.0
10.0
23.0
24.0
Age (years)
Male sex
53.7
50.0
Age (years)
Male sex
Hypertension
DM
Smoking
Male sex
Hypertension
DM
Smoking
CAD or MI
Dyslipidemia
Alcohol abuse
Not applicable
75.0
58.3
92.0
17.0
67.0
77.0
72.0
15.0
42.5
15.0
50.0
20.0
Not applicable
Not applicable
Age (years)
Male sex
Hypertension
46.0
62.0
27.0
Not applicable
Age (years)
Male sex
60.4
86.6
Not applicable
3.1
Not applicable
3.0
Milandre
et al.
(1991)13
Smoker et al.
(1986)14
Resta et al.
(1984)15
Yu et al.
(1982)16
Deeb et al.
(1979)17
Nijensohn et
al. (1974)18
Retrospective review of patients with
vertebrobasilar dolichoectasia seen at
Timone University Hospital Center,
Marseille, France (23)
Retrospective review of patients referred to
University of Iowa Neurology or Neuroophtalmology departments, Iowa City, IA,
USA with vertebrobasilar dolichoectasia
(20)
Retrospective review of vertebral
angiographies from patients with
vertebrobasilar dolichoectasia carried out at
University of Bari, Italy (132)
Retrospective review and case–control study
of angiographies performed at National
Hospital, London, UK; the normal arterial
diameters were obtained from 50 controls
(50,000)
Smoker’s criteria
1975–1989
Not applicable
Age (years)
Male sex
Hypertension
62.2
69.0
86.0
Smoker’s criteria
Not applicable
Not applicable
Age (years)
Male sex
Hypertension
65.3
75.0
55.0
Visual inspection—
tortuosity
Not applicable
Not applicable
Not applicable
Visual inspection—arterial
diameters
1959–1980
Age (years)
Male sex
Hypertension DM
CAD or MI
Dyslipidemia
Smoking
Family history‡
Retrospective review of patients that
presented with cranial nerve dysfunction at
University of Pittsburgh, Pittsburgh,
Pennsylvania and Duke University, North
Carolina, USA (250)
Retrospective review of postmortem
examinations of patients with BA fusiform
aneurysm from Mayo Clinic, Rochester,
MN, USA (23)
Visual inspection
Not applicable
60.0
83.0
64.0
9.6
35.0
3.1
74.0
23.0
57.3
50.0
Visual inspection
1952–1972
Housepian et
al. (1958)19
5.8
0.058
4.8
Not applicable
Age (years)
Male sex
Age (years)
Male sex
Hypertension DM
CAD or MI
Dyslipidemia
65.0
65.0
52.0
4.3
54.0
8.6
Not applicable
A retrospective review of brain autopsies
Visual inspection
1914–1956
0.008
Not applicable
(adult and children) carried out from 1914 to
1956 at Columbia University, New York,
NY, USA (8,762)
*Year of first publication. ‡Family history of stroke or aneurysm. Abbreviations: BA, basilar artery; CAD, coronary artery disease; DM, diabetes mellitus; ICA, internal
carotid artery; MCA, middle cerebral artery; MI, myocardial infarction; MRA, Magnetic resonance angiogram; PAD, peripheral artery disease; VA, vertebral artery.
3
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Kwon, H. M. et al. Basilar artery dolichoectasia is associated with paramedian pontine infarction. Cerebrovasc. Dis. 27, 114–118 (2009).
Pico, F. et al. Association of small-vessel disease with dilatative arteriopathy of the brain: neuropathologic evidence. Stroke 38, 1197–1202
(2007).
Passero, S. G., Calchetti, B. & Bartalini, S. Intracranial bleeding in patients with vertebrobasilar dolichoectasia. Stroke 36, 1421–1425
(2005).
Flemming, K.D. et al. Prospective risk of hemorrhage in patients with vertebrobasilar nonsaccular intracranial aneurysm. J. Neurosurg. 101,
82–87 (2004).
Ubogu, E. E. & Zaidat, O. O. Vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiography and risk of stroke and death: a
cohort study. J. Neurol. Neurosurg. Psychiatry 75, 22–26 (2004).
Pico, F., Labreuche, J., Touboul, P. J. & Amarenco, P. Intracranial arterial dolichoectasia and its relation with atherosclerosis and stroke
subtype. Neurology 61, 1736–1742 (2003).
Nakatomi, H. et al. Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms : insight on the mechanism of growth.
Stroke 31, 896–900 (2000).
Ince, B. et al. Dolichoectasia of the intracranial arteries in patients with first ischemic stroke: a population-based study. Neurology 50, 1694–
1698 (1998).
Passero, S. & Filosomi, G. Posterior circulation infarcts in patients with vertebrobasilar dolichoectasia. Stroke 29, 653–659 (1998).
Drake, C. G. & Peerless, S. J. Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J.
Neurosurg. 87, 141–162 (1997).
Anson, J. A., Lawton, M. T. & Spetzler, R. F. Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J. Neurosurg.
84, 185–193 (1996).
Rautenberg, W., Aulich, A., Rother, J., Wentz, K. U. & Hennerici, M. Stroke and dolichoectatic intracranial arteries. Neurol. Res. 14, 201–
203 (1992).
Milandre, L. et al. Vertebrobasilar arterial dolichoectasia. Complications and prognosis. [French] Rev. Neurol. (Paris) 147, 714–722 (1991).
Smoker, W. R. et al. High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic
correlation and review. AJNR Am. J. Neuroradiol. 7, 61–72 (1986).
Resta, M. et al. Clinical-angiographic correlations in 132 patients with megadolichovertebrobasilar anomaly. Neuroradiology 26, 213–216
(1984).
Yu, Y. L., Moseley, I. F., Pullicino, P. & McDonald, W. I. The clinical picture of ectasia of the intracerebral arteries. J. Neurol. Neurosurg.
Psychiatry 45, 29–36 (1982).
Deeb, Z. L., Jannetta, P. J., Rosenbaum, A. E., Kerber, C. W. & Drayer, B. P. Tortuous vertebrobasilar arteries causing cranial nerve
syndromes: screening by computed tomography. J. Comput. Assist. Tomogr. 3, 774–778 (1979).
Nijensohn, D. E., Saez, R. J. & Reagan, T. J. Clinical significance of basilar artery aneurysms. Neurology 24, 301–305 (1974).
4
19.
Housepian, E. M. & Pool, J. L. A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914 to
1956. J. Neuropathol. Exp. Neurol. 17, 409–423 (1958).
5