Abstract Body: Introduction: Dolichoectasia (DE), a condition marked by dilation and tortuosity of intracranial arteries, is related to an increased risk of strokes. While the association between DE and ischemic stroke is well established, the relationship with hemorrhagic stroke remains less clear. We investigated the presence of dolichoectasia in patients with intracerebral hemorrhage (ICH) and examine its impact on clinical outcomes.

Methods: We studied adult spontaneous ICH A retrospective study of patients aged consecutively admitted to an academic medical center between 2012 and 2023 with available hospitalization vascular imaging (CTA and/or MRA). DE was primarily assessed as a composite assessment based on artery arterial diameter cutoffs by either CTA or MRA imaging modality seen either in anterior or posterior circulations. Multivariable logistic regression models assessed DE’s association with poor discharge ICH outcomes (modified Rankin Scale 4-6) after adjusting for relevant covariates. Separate models explored relationships of DE with ICH characteristics (volume, location), and exploratory analyses were performed defining DE based on vascular location.

Results: Of 373 of 860 patients met the inclusion criteria for meeting criteria for analyses, 56.1% were male, mean age was 66, and 29.8% were white. DE was present in 20% of the cohort. Patients with DE were more likely older, white patients. In our regression models, we identified that DE was associated with decreased odds of poor discharge ICH outcomes (adjusted OR 0.49, 95%CI: 0.26-0.92, p=0.03). In exploratory analyses, we did not identify relationships of DE (as a composite assessment) with ICH volume. However, when assessing DE based on anatomical location, we identified that posterior circulation DE was associated with deep ICH location (95%CI: 1.04-4.98, p=0.04). No interactions of age, sex, race, with DE’s association with outcomes were seen.

Conclusion: We identified a high prevalence of DE in our cohort of ICH patients. Furthermore, we identified that the presence of DE was associated with decreased odds of poor ICH outcomes. Further work is warranted to clarify the role of this vasculopathy in ICH pathogenesis and outcomes, especially to identify if flow-related changes mediate the observed improved outcomes.