Intracranial bleeding in patients with vertebrobasilar dolichoectasia

Background and Purpose - Intracranial bleeding in patients with vertebrobasilar dolichoectasia (VBD) is considered uncommon, but there are no precise data to support this opinion. The purpose of this study was to examine the incidence and characteristics of intracranial hemorrhage in patients with VBD and to evaluate factors that may promote bleeding. Methods - We conducted a prospective study of 156 consecutive VDB patients followed-up for an average 9.35 years. The association of demographic, clinical, and imaging features with occurrence of intracranial bleeding was evaluated by multivariate analysis. Survival analysis was used to evaluate rates of incidence. Results - 32 hemorrhagic strokes were observed in 28 patients either as a diagnostic event (n = 10) or during follow-up (n = 22). Of the 32 hemorrhagic events, 6 were subarachnoid hemorrhage and 26 intraparenchymal hemorrhage. Multivariate analysis found an association between intracranial bleeding and maximum diameter of the basilar artery (OR, 4.29; P = 0.009), degree of lateral displacement of the basilar artery (OR, 4.53; P = 0.004), hypertension (OR, 4.74; P = 0.024), use of antiplatelet or anticoagulant agents (OR, 3.07; P = 0.033), and female sex (OR 6.33; P = 0.001). The cumulative proportion of survivors free of hemorrhagic stroke was 88.6 at 5 years and 84.4 at 10 years. Conclusions - Our study showed that intracranial bleeding in patients with VBD is not as uncommon as usually believed. Its occurrence is associated with the degree of ectasia and elongation of the basilar artery and may be favored by hypertension and use of antiplatelet or anticoagulant agents.