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(Stroke. 2007;38:1197.)
© 2007 American Heart Association, Inc.

Original Contributions

Association of Small-Vessel Disease With Dilatative Arteriopathy of the Brain

Neuropathologic Evidence

Fernando Pico, MD; Julien Labreuche, BS; Danielle Seilhean, MD, PhD; Charles Duyckaerts, MD, PhD; Jean-Jacques Hauw, MD Pierre Amarenco, MD

From the Department of Neuropathology Raymond Escourolle, AP-HP Pitié Salpêtrière Hospital (F.P., D.S., C.D., J.-J.H., P.A.), Pierre et Marie Curie University, Paris; the Department of Neurology (F.P.), Versailles Mignot Hospital, Versailles; and Department of Neurology and Stroke Centre (J.L., P.A.), AP-HP Bichat Hospital, University Hospital, Denis Diderot University and Medical School, Paris, France.

Correspondence to Prof Pierre Amarenco, Department of Neurology and Stroke Centre, Bichat University Hospital, 46 rue Henri Huchard, 75018 Paris, France. E-mail pierre.amarenco{at}bch.ap-hop-paris.fr

Background and Purpose— Clinical and imaging studies have reported an independent and intriguing association between intracranial arterial dolichoectasia (IADE) and markers of small-vessel disease (SVD) such as lacune(s). We used a large brain-autopsy collection to investigate the relation between IADE and pathologically assessed cerebral SVD.

Methods— The entire arterial tree from the heart to the intracranial small intracerebral arteries was investigated in 381 consecutive autopsies from patients with stroke. Vascular risk factors, heart status (weight, coronary atherosclerosis, and myocardial infarction), prevalence and severity of atherosclerosis from heart to brain (aortic arch, carotid, vertebral, and intracranial arteries), dolichoectasia, cerebral SVD, and brain tissue lesions (lacune(s), état criblé) were evaluated. Analyses were adjusted for age, sex, and heart weight.

Results— Twenty-three (6%) of 381 patients had IADE, affecting mainly the basilar artery, with a median basilar artery diameter of 6 mm (range, 4 to 9 mm). Patients with IADE had a >2-fold increase in the prevalence of basilar artery plaques and ulcerated plaques in the aortic arch (both P=0.006), but there were no associations with coronary or cervical artery plaques. SVD was more frequent in IADE-positive than in IADE-negative patients (45% vs 18%; P=0.004). The adjusted odds ratio was 3.85 (95% confidence interval, 1.56 to 9.52). Cerebral amyloid angiopathy was not observed in IADE-positive patients.

Conclusions— Compared with stroke patients without IADE, those with IADE were more likely to have pathologic evidence of cerebral SVD and its consequences, independent of age, arterial hypertension, or diabetes mellitus. IADE and cerebral SVD may have unidentified biologic processes in common.

Key Words: dolichoectasia • autopsy • atherosclerosis • lipohyalinosis • small-vessel disease • multilacunes • état criblé