Thiankhaw, K; Panteleienko, L; Stewart, CR; Oliver, R; Mallon, D; Ambler, G; Werring, DJ; (2025) Association of Intracranial Dolichoectasia and Cerebral Small Vessel Disease in Patients With Intracerebral Hemorrhage. Journal of the American Heart Association , 14 (12) , Article e039039. 10.1161/JAHA.124.039039.

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Abstract

BACKGROUND: Intracranial arterial dolichoectasia (IADE) is associated with cerebral small vessel disease (CSVD) in populations with ischemic stroke. Whether IADE is related to CSVD markers in patients with intracerebral hemorrhage (ICH) is unclear but might be relevant for CSVD diagnosis and prognosis. We aimed to investigate the prevalence and associations of IADE in patients with ICH. METHODS: We included consecutive patients with ICH between February 2016 and September 2023. IADE was determined using magnetic resonance angiography based on validated scales assessing vessel diameter, length, and tortuosity. Neuroimaging markers of CSVD were investigated using validated magnetic resonance imaging rating scales. Left ventricular mass (LVM) was determined from transthoracic echocardiography. Multivariable binary logistic regression analyses were used to evaluate associations between IADE and CSVD. RESULTS: We included 138 patients with a mean age of 66.7±11.8 years, 58.0% men. IADE was present in 16 patients (11.6%). LVM was greater in patients with IADE (183.0±61.3 g versus 155.3±51.2 g, P=0.04). Patients with ICH and IADE had significantly higher proportions of deep lacunes (43.8% versus 18.0%, P=0.02) and deep cerebral microbleeds (56.3% versus 27.1%, P=0.02) compared with individuals without IADE. IADE was independently associated with deep lacunes (adjusted odds ratio [OR], 3.10 [95% CI, 1.02–9.55], P=0.04), severe periventricular white matter hyperintensities (adjusted OR, 3.29 [95% CI, 1.00–10.94], P=0.04), and deep cerebral microbleeds (adjusted OR, 2.80 [95% CI, 1.04–8.65], P=0.04). Among these CSVD markers, IADE had a high predictive value for deep cerebral microbleeds with a receiver operating characteristic curve of 0.75 (95% CI, 0.66–0.85). There was no statistically significant association between IADE and lobar ICH (adjusted OR, 1.29 [95% CI, 0.36–4.64], P=0.70) or cerebral amyloid angiopathy (adjusted OR, 0.46 [95% CI, 0.13–1.67], P=0.24). CONCLUSIONS: IADE is found in approximately 12% of patients with ICH and is independently associated with neuroimaging markers of arteriolosclerosis but not cerebral amyloid angiopathy.

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