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(Stroke. 1998;29:2213-2215.)
© 1998 American Heart Association, Inc.

Letters to the Editor

Two Chinese Patients With Vertebrobasilar Dolichoectasia

Raymond T.F. Cheung, MBBS, PhD, MRCP; Windsor Mak, MBBS, MRCP

Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong

To the Editor:

We read with great interest the article, "Posterior Circulation Infarcts in Patients With Vertebrobasilar Dolichoectasia," by Passero and Filosomi.¹ We would like to make the following comments and describe 2 Chinese patients with vertebrobasilar dolichoectasia (VBD) who presented with features of vertebrobasilar stroke. (There is a minor printing mistake in Table 1 of the article, since 12 patients instead of 11 had prior transient ischemic attacks.¹)

First, the authors suggested the following 2 pathophysiological mechanisms of infarction in patients with VBD: (1) infarcts in distal territories (including posterior cerebral artery territory) associated with artery-to-artery embolism and (2) brain stem/cerebellar infarcts associated with branch atheromatous disease. Nevertheless, the authors postulated in the following paragraph that slow flow and distortion were related to infarcts in the posterior cerebral artery territory and that infratentorial infarcts were related to distortion and stretching of the branches of the basilar artery. Finally, the authors also pointed out the importance of superimposed atheromatous changes in precipitating ischemia in pateints with VBD. Thus, we remain confused as to the most likely pathophysiological mechanisms for ischemia in VBD.

Second, VBD is an uncommon vascular anomaly, but the authors were able to study 40 consecutive stroke patients with associated VBD and compare them with another 40 VBD patients without stroke.¹ We are interested in knowing the frequencies of VBD in both stroke patients and patients without stroke. In addition, we would like to know how the authors collected the 40 VBD patients without stroke. Was the . . . [Full Text of this Article]

Stefano Passero, MD

Istituto di Clinica delle Malattie Nervose e Mentali, Università di Siena, Siena, Italy