Consecutive patients admitted with acute ischemic stroke to a single tertiary-care hospital were analyzed. Utilizing semi-automatic vessel segmentation (TeraRecon; Foster City, CA, USA), IADE was defined as at least one major intracranial vessel with abnormal diameter, length, and/or tortuosity index (value ≥2 SD from the population mean). Symptomatic IADE was considered when the infarct was located in the territory of an affected vessel in the absence of an alternative pathogenic explanation.

Among 150 subjects screened, 142 (68 ±13.5 years; 50% female) had vessel imaging done during admission and were included in the analysis. IADE was detected in 58 (40.8%) individuals. A single vessel was affected in 21%, two vessels in 11.3%, and ≥3 vessels in 8.4%. Demographic profile and prevalence of vascular risk factors were similar between stroke patients with and without IADE. IADE was present in 45.5% of patients with large-artery atherosclerosis, 33.3% with small vessel disease, 25% with cardioembolic stroke, and 60.5% with undetermined etiology. Among 110 patients who underwent MRI-DWI verification of infarct location, 17 (15.5%) had IADE affecting the culprit vessel and eight (7.3%) were considered to have symptomatic IADE.