{"id":"45998","type":"article","url":"https://hartvaat.nl/2026/05/06/dolichoectasie-van-hersenarterien-niet-stenose-drijft-lacunair-cva-en-cerebrale-/","title":"Dolichoectasie van hersenarteriën — niet stenose — drijft lacunair CVA en cerebrale small-vessel-ziekte","title_en":"Implications of Cranial Arterial Stenosis and Dolichoectasia for Cerebral Small-Vessel Disease Etiopathogenesis: Findings From a Prospective Mild Stroke Cohort","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.079493","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.079493","authors":["Fei Han"],"significance":7,"published":"2026-07-10","source_date":"2026-05-06","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/esc-richtlijn-endocarditis-2023/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"Prospective cohort study in 229 patients (mean age 65.9 years; 57.2% lacunar stroke) with MRI at baseline and 1 year, plus systematic review. Large-artery stenosis (LAS, ≥50%) was present in 20.5% and basilar artery dolichoectasia in 15.7%. After adjustment, LAS was associated with lower odds of lacunar versus non-lacunar stroke (OR 0.49; 95% CI 0.23-0.99) and not with cSVD markers or incident infarcts. By contrast, basilar artery dolichoectasia was strongly associated with lacunar stroke (OR 4.67; 95% CI 1.87-13.14), higher cSVD scores (OR 2.57), incident infarcts (75% subcortical; OR 2.29), and greater progression of white matter hyperintensities over 1 year. Similar associations for wider intracranial arteries. The findings support a non-atheromatous, intrinsic microvascular pathology — particularly segmental arteriolar disorganisation — as the principal mechanism of lacunar stroke and cSVD, with mechanism-specific diagnostic and therapeutic strategies as the logical implication.","created":"2026-07-03T20:27:03Z","updated":"2026-07-04T19:27:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Prospectieve cohortstudie bij 229 patiënten (gemiddelde leeftijd 65,9 jaar; 57,2% lacunair CVA) met MRI op baseline en na 1 jaar, plus systematische review. Grote-arteriële stenose (LAS, ≥50%) kwam voor bij 20,5% en basilaire arterie-dolichoectasie bij 15,7%. Na correctie was LAS geassocieerd met lagere kans op lacunair versus niet-lacunair CVA (OR 0,49; 95%-BI 0,23-0,99) en níet met cSVD-markers of nieuwe infarcten. Daarentegen was basilaire-arteriedolichoectasie sterk geassocieerd met lacunair CVA (OR 4,67; 95%-BI 1,87-13,14), hogere cSVD-scores (OR 2,57), nieuwe infarcten (75% subcorticaal; OR 2,29) en grotere progressie van witte-stof-laesies over 1 jaar. Vergelijkbare verbanden voor bredere intracraniale arteriën. De resultaten ondersteunen een niet-atheromateuze, intrinsieke microvasculaire pathologie — vooral segmentale arteriolaire desorganisatie — als hoofdmechanisme van lacunair CVA en cSVD, met mechanismespecifieke diagnostische en therapeutische strategieën als logische consequentie.","abstract_original":"Background: Stenosis and dolichoectasia of cranial arteries likely reflect distinct mechanisms. Their contributions to lacunar stroke and cerebral small-vessel disease (cSVD) remain contentious. We investigated the associations of large-artery stenosis (LAS) and arterial widening with stroke subtype, cSVD markers, incident infarcts, and clinical outcomes.Methods: We prospectively recruited patients with lacunar or mild nonlacunar stroke, with demographic, stroke-related, cognitive, functional, and magnetic resonance imaging (index and incident infarcts, cSVD markers) assessments at baseline and 1 year. LAS was defined as ≥50% intracranial or cervical artery stenosis; basilar artery dolichoectasia was defined by basilar artery diameter, bifurcation height, and lateral displacement; and intracranial carotid and middle cerebral artery diameters were also measured. Associations were estimated from multivariable logistic, linear, and proportional odds regression models adjusted for age, sex, and vascular risk factors. We further conducted a systematic literature review to synthesize evidence on relationships between large-artery pathology and cSVD.Results: Among 229 patients (mean age, 65.9±11.1 years; 131 [57.2% ] lacunar stroke), LAS and basilar artery dolichoectasia were present in 20.5% and 15.7%, respectively. After adjustment, LAS (odds ratio, 0.49 [95% CI, 0.23–0.99]) and the presence of any embolic source were associated with lower odds of lacunar versus non-lacunar stroke, and not with cSVD markers or incident infarcts. In contrast, basilar artery dolichoectasia was strongly associated with lacunar stroke (odds ratio, 4.67 [95% CI, 1.87–13.14]), higher cSVD scores (ordinal analysis; odds ratio, 2.57 [95% CI, 1.28–5.25]), incident infarcts (75% subcortical; odds ratio, 2.29 [95% CI, 1.01–5.14]), and greater progression of white matter hyperintensities over 1 year (β, 0.15 [95% CI, 0.01–0.29] per log10-transformed volume). Similar associations were observed for wider intracranial arteries. The systematic review supported these findings.Conclusions: cSVD, including lacunar stroke, was unrelated to LAS but strongly associated with dolichoectasia and wider arteries. These findings support a nonatheromatous, intrinsic microvascular pathology, particularly segmental arteriolar disorganization, as the principal mechanism of lacunar stroke and cSVD. Mechanism-specific diagnostic and therapeutic strategies are warranted."}