Natural history of vertebrobasilar dolichoectasia.
OBJECTIVE
The long-term prognosis of patients with vertebrobasilar dolichoectasia (VBD) is unknown. The purpose of this study was to explore the natural history of VBD, evaluate its progression, and examine factors that may influence the clinical course of this condition.


METHODS
We conducted a prospective clinical and imaging follow-up study of 156 consecutive patients with VDB followed for an average of 11.7 years. Predictors of events were evaluated by multivariate analysis. Survival analysis was used to evaluate rates of incidence.


RESULTS
During follow-up, 93 patients (60%) experienced at least one event: 75 patients had stroke (59 ischemic and 21 hemorrhagic), 31 patients had new compressive symptoms, and 2 patients had hydrocephalus. Events were significantly associated with the severity of VBD, i.e., diameter, height of bifurcation, and lateral displacement of the basilar artery. During follow-up VBD progressed in 43% of patients. Progression of VBD was associated with a higher morbidity and mortality. The cumulative proportion of survivors free of adverse health event was 54.1 at 5 years, 39.5 at 10 years, and 23.5 at 15 years. During follow-up, 62 patients died and stroke was the most common cause of death.


CONCLUSIONS
The long-term prognosis of patients with vertebrobasilar dolichoectasia (VBD) depended mainly on the severity of the condition at diagnosis and on its evolutionary characteristics. Progression of VBD exposed patients to high risk of adverse events, especially stroke.
Passero
Stefano G
SG
Department of Neurosciences, Neurology Unit, University of Siena, Italy. passero@unisi.it
Rossi
Simone
S
D001488:Basilar Artery / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000145:classification / Q000209:etiology; D016009:Chi-Square Distribution; D005069:Evaluation Studies as Topic; D006801:Humans; D008137:Longitudinal Studies; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D016019:Survival Analysis; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality