title: Vertebrobasilar ectasia in patients with lacunar stroke: the secondary prevention of small subcortical strokes trial.
abstract: BACKGROUND
  The clinical implications of vertebrobasilar ectasia (VBE) in patients with cerebral small-artery disease are not well defined. We investigated whether VBE is associated with recurrent stroke, major hemorrhage, and death in a large cohort of patients with recent lacunar stroke.
  
  
  METHODS
  Maximum diameters of the vertebral and basilar arteries were measured by magnetic resonance angiography and computed tomographic angiography in 2621 participants in the Secondary Prevention of Small Subcortical Strokes trial. VBE was defined a priori as basilar artery greater than 4.5 mm and/or vertebral artery greater than 4.0 mm. Patient characteristics and risks of stroke recurrence and mortality during follow-up (median, 3.5 years) were compared between patients with and without VBE.
  
  
  RESULTS
  VBE affecting 1 or more arteries was present in 200 (7.6%) patients. Patient features independently associated with VBE were increasing age, male sex, white race ethnicity, hypertension, and higher baseline diastolic blood pressure. Baseline systolic blood pressure was inversely associated with VBE. After adjustment for other risk factors, VBE was not predictive of recurrent stroke (hazard ratio [HR], 1.3; 95% confidence interval [CI], .85-1.9) or major hemorrhage (HR, 1.5; CI, .94-2.6), but was of death (HR, 1.7; CI, 1.1-2.7).
  
  
  CONCLUSIONS
  In this large well-characterized cohort of patients with recent lacunar stroke, VBE was predictive of death but not of recurrent stroke or major hemorrhage. In these exploratory analyses, the frequency of VBE was directly related to diastolic blood pressure but inversely related to systolic blood pressure.
authors: Division of Neurology, Faculty of Medicine, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: nakazima04@gmail.com.
authors: Makoto
authors: M
authors: Nakajima
authors: Biostatistics Consultant, Minot, North Dakota.
authors: Lesly A
authors: LA
authors: Pearce
authors: Department of Neurology, UCLA Stroke Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Nobuyuki
authors: N
authors: Ohara
authors: Division of Neurology, Faculty of Medicine, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Thalia S
authors: TS
authors: Field
authors: Department of Radiology, The University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
authors: Carlos
authors: C
authors: Bazan
authors: Department of Neurology, University of Minnesota, Minneapolis, Minnesota.
authors: David C
authors: DC
authors: Anderson
authors: Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors: Robert G
authors: RG
authors: Hart
authors: Division of Neurology, Faculty of Medicine, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Oscar R
authors: OR
authors: Benavente
mesh_terms: D000368:Aged; D001488:Basilar Artery / Q000473:pathology*; D000077144:Clopidogrel; D004108:Dilatation, Pathologic / Q000209:etiology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D055502:Secondary Prevention; D018709:Statistics, Nonparametric; D059409:Stroke, Lacunar / Q000150:complications* / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Lacunar stroke; arterial diameter; death; prognosis; recurrent stroke; vertebrobasilar ectasia