Intracranial Arterial Dolichoectasia in Spontaneous Intracerebral Hemorrhage: A Retrospective Cross-Sectional Study of Morphometric Features and Cerebral Small Vessel Disease.

Objectives

The aim of this study was to determine the prevalence and distribution of intracranial arterial dolichoectasia (IADE) across the anterior and posterior circulations and assess its association with cerebral small vessel disease (CSVD) imaging markers in patients with spontaneous intracerebral hemorrhage (ICH).

Methods

This retrospective cross-sectional study included 174 ICH patients. Three-dimensional vascular reconstruction was used to assess cavernous internal carotid artery morphology, vertebrobasilar dolichoectasia, and exploratory middle cerebral artery (MCA) tortuosity. IADE was defined by Type III-IV cavernous internal carotid artery morphology and/or vertebrobasilar dolichoectasia. Multivariable logistic regression was adjusted for age, sex, hypertension, diabetes mellitus, and previous stroke.

Results

IADE was present in 52 patients (29.9%) and was observed more frequently in CSVD-related ICH than in macrovascular ICH (32.9% versus 14.3%; p = 0.049). Among patients with CSVD-related ICH, IADE was associated with deep cerebral microbleeds (adjusted odds ratio [OR], 3.42; 95% CI, 1.27-9.20), severe basal ganglia enlarged perivascular spaces (adjusted OR, 4.24; 95% CI, 1.72-10.46), and deep white matter hyperintensity grade ≥ 2 (adjusted OR, 3.71; 95% CI, 1.59-8.65). These associations were still significant after false discovery rate correction. No significant association was observed with lobar cerebral microbleeds. Exploratory analyses showed higher maximum and mean bilateral MCA tortuosity indices in patients with IADE.

Conclusions

IADE was present in approximately one third of patients with ICH and was observed more frequently in CSVD-related than in macrovascular ICH in this cohort. Its association with deep CSVD imaging markers suggests a possible link between IADE and deep small-vessel disease, while the MCA findings remain exploratory.