Vertebrobasillar dolichoectasia Internal carotid dolichoectasia Most commonly caused by hypertension, continued stress on the walls of the artery will degrade the vessel wall by damaging and loosening the collagen and elastin meshwork which comprises the intima.

Similarly, hypercholesterolemia or hyperlipidemia can also provide sufficient trauma to the vessel wall resulting in dolichoectasia.

As the arrangement of connective tissue is disturbed, the vessel wall is no longer able to hold its original conformation and begins to unravel due to the continued hypertension.

Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) are more likely to be subject to dolichoectasias.

[1] In cases involving the basilar artery (VBD), pathology can occur due to direct compression of cranial nerves, by ischemia related to the dolichoectatic vessel, or by the development of hydrocephalus.