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Intracranial arterial dolichoectasia is associated with enlarged descending thoracic aorta

From the Department of Neurology, Mignot Versailles Hospital (Dr. Pico), Versailles; Department of Neurology and Stroke Centre, Bichat University Hospital and Medical School, Denis Diderot University–Paris VII and "Formation de Recherche en Neurologie Vasculaire" (Association Claude Bernard) (J. Labreuche, and Drs. Touboul and Amarenco), Paris; and the Department of Cardiology, Saint Antoine Hospital (Dr. Cohen), Paris, France.

Address correspondence and reprint requests to Professor Pierre Amarenco, Department of Neurology and Stroke Centre, Bichat University Hospital and Medical School, 46 rue Henri Huchard, 75018 Paris, France; e-mail: pierre.amarenco{at}bch.ap-hop-paris.fr

Background: Intracranial arterial dolichoectasia (IADE) is defined as an increase in length and diameter of the intracranial arteries and is present in 12% of stroke patients. The pathophysiology is unknown; some data suggest that IADE is not merely a complication of atherosclerosis, but a distinct arteriopathy characterized by loss of elastic tissue in the media.

Objective: To investigate the relationship between IADE and transesophageal echocardiography (TEE) variables such as ascending and descending thoracic aorta diameters.

Methods: The sample included 154 patients with brain infarction (BI) and with measurement of the descending thoracic aorta on TEE. IADE was diagnosed by consensus between two neurologists. Information on demographic characteristics and risk factors was collected using a structured questionnaire, and a carotid ultrasound scan was performed.

Results: IADE was identified in 23 of the 154 stroke patients (15%). The mean diameter (±SD) of the descending thoracic aorta was significantly higher in the IADE(+) than in the 131 IADE(–) stroke patients (mean ± SD 26.6 ± 3.6 vs 24.8 ± 2.7 mm). The proportion of IADE increased regularly with the quartiles of descending thoracic aorta diameter: 5%, 13%, 18%, and 24% (test of linear trend, p = 0.02). The adjusted OR (95% CI) of IADE associated with a 1 mm increase in descending thoracic aorta diameter was 1.22 (95% CI, 1.02 to 1.45).

Conclusion: Patients with intracranial arterial dolichoectasia (IADE) have larger descending thoracic aorta diameters than non-IADE patients, suggesting that the underlying process causing IADE also affects the descending thoracic aorta.

Received April 13, 2004. Accepted in final form July 27, 2004.

*A list of investigators, with institutions, is available at http://www.ccr.jussieu.fr/GENIC/welcome.html

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