Abstract Details

Title Hemodynamic Consequences of Brain Arterial Dilation in Patients with Dolichoectasia-related Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S44 - Evidence-based Stroke Interventions and Prognostic Tools (2:24 PM-2:36 PM)

Poster/Presentation
Number 008

Objective Evaluate the relationship between arterial dilation and blood flow velocities measured by transcranial Doppler (TCD) in DE-related stroke patients.

Background The abnormal enlargement of intracranial arteries, known as dolichoectasia (DE), is a recognized cause of both thromboembolic (TEMB) and small-vessel occlusive ischemic stroke. However, hemodynamic alterations linking DE to ischemic mechanisms remain uncharacterized.

Design/Methods Consecutive ischemic stroke patients (August 2024–July 2025) were screened for DE of the intracranial carotid, middle cerebral, and basilar arteries. DE-related stroke was defined as an acute infarct within the territory of a dolichoectatic artery (diameter ≥2 SD above sex-specific means) without an alternative stroke etiology. Ischemic stroke pattern was defined by brain imaging and analysis included only those with TCD available. Diameters and mean flow velocities (MFV) were standardized for comparison; abnormally low MFV was defined as <2 SD below population means. Associations between diameters and MFV were analyzed using regression models adjusted for age, sex, height, hemoglobin, and mean arterial pressure at TCD time.

Results

Of 494 ischemic stroke cases, 59 (11.9%) were suspected to be DE-related, with 31 meeting inclusion criteria (mean age 68.6 ±11.1 years; 48.4% men, 54.8% TEMB), yielding 144 arteries for analysis. Overall, arterial diameters and MFV mean z-scores were 2.2 ±1.4 and –1.2 ±1.1, respectively, showing an independent inverse association (β −0.25; 95%CI −0.37-−0.13). Individuals with TEMB ischemic pattern had larger diameters (aOR 1.44; 95%CI 1.06-1.95) and lower MFV (aOR 0.67; 95%CI 0.45-0.98) compared to non-TEMB strokes. Symptomatic arteries with TEMB ischemic pattern were more likely to have abnormally low MFV (68.8% vs 14.3%; aOR 8.84; 95% CI 1.10–70.98).

Conclusions Arterial enlargement in DE is associated with low-flow hemodynamics, particularly in TEMB strokes, suggesting DE promotes intraluminal thrombosis by flow stagnation. TCD-derived velocities may serve to grade DE severity and potentially guide prognosis and therapy.

Authors/Disclosures
Lauren Tierney, BS PRESENTER	Miss Tierney has nothing to disclose.
Sebastian A. Vargas-George	Mr. Vargas-George has nothing to disclose.
Angelica Morales, MS	Miss Morales has nothing to disclose.
Jorge I. Lombardi, MD	Dr. Lombardi has nothing to disclose.
Yosdely Cabrera, NP	Mrs. Cabrera has nothing to disclose.
Tatjana Rundek, MD, PhD	The institution of Dr. Rundek has received research support from NIH.
Jose Gutierrez, MD (Columbia University)	Dr. Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cardiovascular Research Foundation. Dr. Gutierrez has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for White and Rusell. Dr. Gutierrez has received research support from NIH. Dr. Gutierrez has received publishing royalties from a publication relating to health care. Dr. Gutierrez has received publishing royalties from a publication relating to health care.
Sebastian Koch, MD (University of Miami)	Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.
Jose G. Romano, MD, FAAN (University of Miami, Miller School of Medicine)	Dr. Romano has stock in Vycor Medical/NovaVision. The institution of Dr. Romano has received research support from NIH/NINDS. The institution of Dr. Romano has received research support from NIH/NHLBI.
Victor J. Del Brutto, MD	The institution of Dr. Del Brutto has received research support from Florida Health Department. The institution of Dr. Del Brutto has received research support from american heart association.

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