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Meta-Analysis
. 2024 Feb;271(2):772-781.
doi: 10.1007/s00415-023-12094-2. Epub 2023 Nov 29.

Relationships between intracranial arterial dolichoectasia and small vessel disease in patients with ischaemic stroke: a systematic review and meta-analysis

Kitti Thiankhaw  1   2 , Hatice Ozkan  2 , Gareth Ambler  3 , David J Werring  4
Affiliations
Meta-Analysis

Relationships between intracranial arterial dolichoectasia and small vessel disease in patients with ischaemic stroke: a systematic review and meta-analysis

Kitti Thiankhaw et al. J Neurol. 2024 Feb.

Abstract

Background: Intracranial arterial dolichoectasia (IADE) is a common arterial finding of dilation, elongation, or both, affecting large intracranial vessels, and associated with vascular risk factors, including hypertension. Associations of IADE with neuroimaging cerebral small vessel disease (CSVD) may be relevant for diagnosis and prognosis in patients with stroke. The study aimed to conduct an updated systematic review and meta-analysis of observational studies to investigate the relationships of IADE with well-defined CSVD markers in patients with ischaemic stroke.

Methods: We systematically searched PubMed, Embase, and Scopus for studies on IADE in ischaemic stroke patients with fulfilling predefined inclusion criteria. We pooled data to conduct a meta-analysis to compare the prevalence of SVD markers between patients with and without IADE groups using risk ratios (RRs) and 95% confidence intervals (CIs).

Results: From 157 retrieved abstracts, we included six studies from seven publications comprising 6102 patients with ischaemic stroke. The mean age of patients was 52.8 years, and 3691 (60.5%) were male. IADE was diagnosed in 11.4% (95% CI 8.9-13.9) (761) of included patients; 51.8% (3160) had hypertension. Compared to patients without IADE, individuals diagnosed with IADE had a significantly increased prevalence of lacune (RR 1.67, 95% CI 1.36-2.06, P < 0.01, I2 = 0.00%), cerebral microbleeds (CMBs) (RR 2.56, 95% CI 1.53-4.28, P < 0.01, I2 = 84.95%) and white matter hyperintensities (WMHs) (RR 2.17, 95% CI 1.84-2.56, P < 0.01, I2 = 0.00%).

Conclusions: In patients with ischaemic stroke, IADE is associated with a higher prevalence of CSVD markers, including lacunes, CMBs, and WMHs. Further studies are needed to clarify the mechanisms underlying these associations and their potential relevance for the understanding, diagnosis, and treatment of CSVD.

Keywords: Cerebral microbleeds; Dolichoectasia; Ischaemic stroke; Small vessel disease; White matter hyperintensities.

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Conflict of interest statement

All authors declared that they have no competing or conflicting interests.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram summarising the study selection process from PubMed, Embase, and Scopus searches for the studies included in the meta-analysis. SVD small vessel disease
Fig. 2
Fig. 2
Forest plots of the risk (RR and 95% CI) of small vessel disease markers in ischaemic stroke patients with intracranial arterial dolichoectasia (A). lacunes (B). CMBs (C). WMHs. CI confidence interval; CMBs cerebral microbleeds; IADE intracranial arterial dolichoectasia; WMHs white matter hyperintensities
Fig. 3
Fig. 3
Bubble plots with fitted meta-regression lines of the risk of cerebral microbleeds and the percentage of male participants. The size of the bubbles represents the precision of the studies. CI confidence interval
See this image and copyright information in PMC

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