Transcranial doppler findings in basilar artery dolichoectasia: a case control study

AJBM crossMark
American Journal of BioMedicine Volume 9, Issue 4, pages 208-219

Zaid Ali Hussein1, Haider N. Al-Tameemi*2, Hayder Kadhum Hassoun2, Ahmed MH Almudhafar2

Author Affiliations
∗Correspondence author e-mail: haidern.altameemi@uokufa.edu.iq: 1Middle Euphrates Neuroscience Center, Al-Najaf health directorate, 2Middle Euphrates Neuroscience Center and Faculty of Medicine/ University of Kufa.

 

Abstract

Basilar artery dolichoectasia (BAD) is a disorder characterized by dilatation, elongation and tortuosity of the basilar artery. Transcranial Doppler ultrasound (TCD) is a useful tool that can detect blood flow in intracranial vessels including basilar artery (BA). Few studies have been conducted on blood flow changes in BAD. This study was conducted to evaluate the Doppler parameters in dolichoectatic BA and to assess if there is any difference in TCD findings between stroke and non-stroke BAD patients.  A case-control study was conducted on 35 patients diagnosed with BAD (26 male, 9 female) and 35 age- and gender-matched control group (without BAD) at the Middle Euphrates Neuroscience Center, Al-Sader Medical City, Al-Najaf, Iraq. Dolichoectasia was diagnosed on non-enhanced brain CT scan using established imaging criteria according to Dan Deng et al criteria. Doppler flow for control and stroke cases was recorded. The parameters measured on TCD were peak systolic velocity (PSV), end diastolic velocity (EDV) mean blood velocity (MBV), pulsatility index (PI) and resistive index (RI). After logistic regression for adjustment for the significant confounders, there was statistically significant difference in Doppler parameters between both groups including decrease in each of PSV, EDV and MBV while both PI and RI weren’t statistically significant. Among BAD patients, there was statistically significant difference in all TCD parameters between stroke and non-stroke patients (PSV EDV, MBV, PI and RI). BAD was associated with a decrease in flow velocities as measured by TCD. Furthermore, among BAD patients, those with stroke had lower values for all Doppler parameters than non-stroke patients.

Keywords: Basilar artery, Dolichoectasia, Transcranial Doppler, stroke, Computed tomography

Copyright © 2021 by The American Society for BioMedicine and BM-Publisher, Inc.

Article citationReferencesFull-Text/PDFBecome reviewer
The citation data is computed by the following citation measuring services:

Cited by (CrossRef)
Google Scholar

  1. Pedro T. Vieco, Edward E. Maurin III, and Cordell E. Gross. Vertebrobasilar Dolichoectasia: Evaluation with CT Angiography. AJNR 1997; 18: 1385-1388.
  2. Smoker WR, Corbett JJ, Gentry LR, Keyes WD, Price MJ, McKusker S. High-resolution computed tomography of the basilar artery: Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review. Am J Neuroradiol 1986; 7: 61-72.3.
  3. Ikeda K, Nakamura Y, Hirayama T, et al. Cardiovascular risk and neuroradiological profiles in asymptomatic vertebrobasilar dolichoectasia. Cerebrovasc Dis, 2010; 30: 23- 28.
    https://doi.org/10.1159/000313440
  4. Gutierrez J, Sacco RL, Wright CB. Dolichoectasia: an evolving arterial disease. Nat Rev Neurol 2011; 7(1): 41-50.
    https://doi.org/10.1038/nrneurol.2010.181
  5. Ubogu EE, Zaidat OO. Vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiography and risk of stroke and death: a cohort study. J Neurol Neurosurg Psychiatry. 2004; 75(1): 22-6.
  6. Mizutani T. A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. J Neurosurg 1996; 84(6): 962-71.
    https://doi.org/10.3171/jns.1996.84.6.0962
  7. Herpers M, Lodder J, Janevski B, Van der Lugt PJ. The symptomatology of megadolicho basilar artery. Clin Neurol Neurosurg 1983; 85(4): 203-12.
    https://doi.org/10.1016/0303-8467(83)90070-7
  8. Dziewasa R, Freund M, Ludemann P, et al. Treatment options in vertebrobasilar dolichoectasia-case report and review of the literature. European neurology 2003; 49: 245-7.
    https://doi.org/10.1159/000070196
  9. Garzuly F, Marodi L, Erdos M, et al. Megadolichobasilar anomaly with thrombosis in a family with Fabry's disease and a novel mutation in the alpha-galactosidase A gene. Brain: A Journal of Neurology 2005; 128: 2078-83.
    https://doi.org/10.1093/brain/awh546
  10. Flemming KD, Wiebers DO, Brown RD Jr, et al. The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Cerebrovascular Diseases 2005; 20: 270-9.
    https://doi.org/10.1159/000087710
  11. Toyoshima Y, Emura I, Umeda Y, Fujita N, Kakita A, Takahashi H. Vertebral basilar system dolichoectasia with marked infiltration of IgG4-containing plasma cells: a manifestation of IgG4-related disease? Neuropathology: Official Journal of the Japanese Society of Neuropathology 2012; 32: 100-4. https://doi.org/10.1111/j.1440-1789.2011.01227.x
  12. Rautenberg W, Aulich A, Rother J, Wentz KU, Hennerici M. Stroke and dolichoectatic intracranial arteries. Neurol Res 1992; 14(2 suppl): 201-203.
    https://doi.org/10.1080/01616412.1992.11740052
  13. Passero SG, Calchetti B, Bartalini S. Intracranial bleeding in patients with vertebrobasilar dolichoectasia. Stroke 2005; 36(7): 1421-1425.
    https://doi.org/10.1161/01.STR.0000172311.64662.9c
  14. Graf S, Schischma A, Eberhardt KE, Istel R, Stiasny B, Schulze BD. Intracranial aneurysms and dolichoectasia in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2002; 17(5): 819-823.
    https://doi.org/10.1093/ndt/17.5.819
  15. Jamjoom AB, Rawlinson JN, Coakham HB. Multiple neurological lesions due to vertebrobasilar dolichoectasia. Br J Neurosurg 1990; 4(2):147-154.
    https://doi.org/10.3109/02688699008992715
  16. Mortzos P, Sorensen TL. Visual loss, homonymous hemianopia, and unilateral optic neuropathy as the presenting symptoms of vertebrobasilar dolichoectasia. Case Rep Ophthalmol Med 2013; 2013: 562397.
    https://doi.org/10.1155/2013/562397
  17. Yuan YJ, Xu K, Luo Q, Yu JL. Research progress on vertebrobasilar dolichoectasia. Int J Med Sci 2014; 11(10): 1039-1048.
    https://doi.org/10.7150/ijms.8566
  18. Hassoun HK, Aubaid HN and Abass AM. Vertebrobasilar Dolichoectasia: Clinical Neuroimaging Correlation. The Iraqi Postgraduate Medical Journal. 2015;14.
  19. Yang XS, Li ST, Zhong J, et al. Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: technique notes. Acta Neurochir (Wien) 2012; 154(5): 793-797.
    https://doi.org/10.1007/s00701-012-1320-6
  20. Titlic M, Tonkic A, Jukic I, Buca A, Kolic K, Batinic T. Tinnitus caused by vertebrobasilar dolichoectasia. Bratisl Lek Listy (Tlacene Vyd) 2007; 108(10-11): 455-457.
  21. Pereira-Filho A, Faria M, Bleil C, Kraemer JL. Brainstem compression syndrome caused by vertebrobasilar dolichoectasia: microvascular repositioning technique. Arq Neuropsiquiatr 2008; 66(2B): 408-411.
    https://doi.org/10.1590/S0004-282X2008000300026
  22. Savitz SI, Ronthal M, Caplan LR. Vertebral artery compression of the medulla. Arch Neurol 2006; 63(2): 234-241.
    https://doi.org/10.1001/archneur.63.2.234
  23. Vieco PT, Maurin EE 3rd, Gross CE. Vertebrobasilar dolichoectasia: evaluation with CT angiography. AJNR Am J Neuroradiol 1997; 18(7): 1385-1388.
  24. Forster A, Ssozi J, Al-Zghloul M, Brockmann MA, Kerl HU, Groden C. A comparison of CT/CT angiography and MRI/ MR angiography for imaging of vertebrobasilar dolichoectasia. Clin Neuroradiol 2014; 24(4): 347-353.
    https://doi.org/10.1007/s00062-013-0261-7
  25. Forster A, Kerl HU, Wenz H, M¨ urle B, Habich S, Groden C. Fluid Attenuated Inversion Recovery Vascular Hyperintensities Possibly Indicate Slow Arterial Blood Flow in Vertebrobasilar Dolichoectasia, J Neuroimaging 2014; 00: 1-6.
    https://doi.org/10.1111/jon.12177
  26. Smoker WR, Price MJ, Keyes WD, Corbett JJ, Gentry LR. High resolution computed tomography of the basilar artery: Normal size and position. AJNR Am J Neuroradiol 1986; 7(1): 55-60.
  27. Purkayastha S, and Sorond F. Transcranial Doppler Ultrasound: Technique and Application, Semin Neurol 2012; 32(4): 411-420.
    https://doi.org/10.1055/s-0032-1331812
  28. Egido JA, Carod J, Cuadrado ML, González JL, Dolichoectasia of multiple cranial arteries. Findings on neuroimaging and transcranial Doppler Rev Neurol. 1997; 25(142): 872-4.
  29. Deng D, Cheng FB, Zhang Y, Zhou HW, Feng Y, Feng JC. Morphological analysis of the vertebral and basilar arteries in the Chinese population provides greater diagnostic accuracy of vertebrobasilar dolichoectasia and reveals gender differences, Surg Radiol Anat 2012; 34: 645-650.
    https://doi.org/10.1007/s00276-012-0960-9
  30. Pico F, Labreuche J, Touboul PJ, Amarenco P, GENIC Investigators. Intracranial arterial dolichoectasia and its relation with atherosclerosis and stroke subtype. Neurology. 2003; 61: 1736-42.
    https://doi.org/10.1212/01.WNL.0000103168.14885.A8
  31. Dikanovic M , Hozo I, Kokic S, et al. Transcranial Doppler ultrasound assessment of intracranial hemodynamics in patients with type 2 diabetes mellitus. Ann Saudi Med 2005; 25(6): 486-8.
    https://doi.org/10.5144/0256-4947.2005.486
  32. Babikian V. Sloan MA, Burdette D, Pochay VE. The effects of dolichoectasia on transcranial Doppler measurements. J Neuroimag 1992; 2: 19-24.
    https://doi.org/10.1111/jon19922119\
  33. Wu X, Xu Y, Hong B, Zhao WY, Huang QH, Liu JM. Endovascular reconstruction for treatment of vertebrobasilar dolichoectasia: long-term outcomes. AJNR Am J Neuroradiol 2013; 34(3): 583-588.
    https://doi.org/10.3174/ajnr.A3248
  34. Bada HS, Hajjar W, Chua C, Sumner DS. Noninvasive diagnosis of neonatal asphyxia and intraventricular hemorrhage by Doppler ultrasound. Pediatrics 1979; 95: 775-779
    https://doi.org/10.1016/S0022-3476(79)80735-0
  35. Giulioni M, Ursino M, Alvisi C. Correlations among intracranial pulsatility, intracranial hemodynamics and transcranial Doppler wave form: literature review and hypothesis for future studies. Neurosurgery 1988; 22:807- 812
    https://doi.org/10.1227/00006123-198805000-00001
  36. Farhoudi M, Mehrvar K, Aslanabadi N, et al. Doppler study of cerebral arteries in hypercholesterolemia, Vascular Health and Risk Management 2011; 7: 203-207.
    https://doi.org/10.2147/VHRM.S18663
  37. Kumral E, Kisabay A, Ataç C, Kaya C, Calli C. The mechanism of ischemic stroke in patients with dolichoectatic basilar artery. Eur J Neurol 2005; 12(6): 437-444.
    https://doi.org/10.1111/j.1468-1331.2005.00993.x

READ THE FULL ARTICLE  

Transcranial doppler findings in basilar artery dolichoectasia a case control study

  1. For any technique error please contact us 
Who Can Become a Reviewer?
Any expert in the article's research field can become a reviewer with American Journal of Biomedicine.
  • Editors might ask you to look at a specific aspect of an article,...
  • Find out more

    • Downloads: 431

    Research Article
    http://dx.doi.org/10.18081/2333-5106/9.4/188
    American Journal of BioMedicine Volume 9, Issue 4, pages 208-219
    Received October 10, 2021; revised November 25, 2021; accepted December 05, 2021; published December 14, 2021

    Downloads: 431
    PDF Download this Paper

    How to cite this article
    Hussein ZA,Al-Tameemi HN, Hassoun HK, Almudhafar AM. Transcranial doppler findings in basilar artery dolichoectasia: a case control study. American Journal of BioMedicine 2021;9(4):208-219.
    Research Article
    1. Abstract
    2. Keywords
    3. Introduction
    4. Methods
    5. Results
    6. Discussion
    7. References

    Article metric