Dolichoectasia

Dolichoectasia is a vascular condition characterized by elongation (dolicho-) and dilation (ectasia) of intracranial arteries, most commonly the basilar and vertebrobasilar system. The term is used for a spectrum of arterial abnormalities with tortuosity and ectasia.

Etiology includes age-related degenerative changes in the vessel wall, hypertension, atherosclerosis, and sometimes inherited connective tissue disorders. It can be isolated or occur with generalized arterial tortuosity. Associated risk factors include smoking, dyslipidemia, and chronic hypertension.

Clinical presentation varies; many patients are asymptomatic. Symptoms, when present, may derive from brainstem or cranial nerve compression (for example diplopia, facial numbness, or dysphagia), mass effect, or cerebrovascular events such as thromboembolism leading to ischemic stroke or, less commonly, intracranial hemorrhage.

Diagnosis relies on imaging. MRI and CT angiography show elongated, widened arteries with tortuosity and lateral displacement of the brainstem. Radiologic criteria for basilar artery dolichoectasia are variable but may include increased basilar artery length and/or diameter beyond established thresholds. Features on imaging may include a basilar artery that projects laterally and a widened, serpentine course.

Management focuses on risk factor control and symptom management; no specific cure. Antiplatelet therapy is used for ischemic risk in the absence of contraindications; anticoagulation is considered selectively. Surgical or endovascular treatment is rarely performed due to high risk and limited evidence, reserved for selected cases with focal compressive symptoms or large aneurysmal dilatations. Prognosis is variable, with increased risk of stroke and death in some patients, especially when symptoms or complications are present.