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Zimmermann S, Weißenfels M, Krümmer N, Michalski D, Weise G, Branzan D, Pelz JO. Long-Term Course of Circulating Elastin, Collagen Type I, and Collagen Type III in Patients with Spontaneous Cervical Artery Dissection: a Prospective Multicenter Study. Transl Stroke Res 2025; 16:238-247. [PMID: 37945800 PMCID: PMC11976821 DOI: 10.1007/s12975-023-01207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
An impaired integrity of vascular elements and the extracellular matrix (ECM) has been discussed to play a critical role in the pathophysiology of spontaneous cervical artery dissection (sCAD). This study aimed to explore the temporal course of circulating elastin, collagen type I, and collagen type III in patients with sCAD and evaluated their eligibility as diagnostic biomarkers. Patients with sCAD were prospectively enrolled in four German stroke centers. Blood samples were collected at baseline (acute phase), at day 10 ± 3 (subacute phase), and after 6 ± 1 months (chronic phase). Patients with acute ischemic stroke not related to sCAD, healthy probands, and patients undergoing thromboendarterectomy of the carotid artery served as control groups. Serum levels of elastin and collagen types I and III were determined by ELISAs. Fifty-seven patients with sCAD were enrolled. Compared to all three control groups, patients with sCAD had significantly lower levels of elastin and collagen type III at baseline and after 6 months. Compared to healthy probands, patients with sCAD showed similar collagen type I levels at baseline and in the subacute phase, but significantly increased levels after 6 months. As serum levels of elastin, collagen types I and III were not elevated in the acute phase, they do not appear eligible as biomarkers for the diagnosis of sCAD. Persisting low serum levels of elastin and collagen type III towards the chronic phase of sCAD strengthens the hypothesis of a subtle, in most cases clinically inapparent affection of the ECM in patients with sCAD.
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Affiliation(s)
- Silke Zimmermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | | | - Norma Krümmer
- Department of Neurology, Klinikum Altenburger Land, Altenburg, Germany
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Gesa Weise
- Department of Neurology, Sana Kliniken Leipziger Land, Borna, Germany
| | - Daniela Branzan
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Johann Otto Pelz
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany.
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Mandel DM, Shu L, Chang C, Jack N, Leon Guerrero CR, Henninger N, Muppa J, Affan M, Ul Haq Lodhi O, Heldner MR, Antonenko K, Seiffge D, Arnold M, Salehi Omran S, Crandall R, Lester E, Lopez Mena D, Arauz A, Nehme A, Boulanger M, Touze E, Sousa JA, Sargento-Freitas J, Barata V, Castro-Chaves P, Brito MT, Khan M, Mallick D, Rothstein A, Khazaal O, Kaufman JE, Engelter ST, Traenka C, Aguiar de Sousa D, Soares M, Rosa S, Zhou LW, Gandhi P, Field TS, Mancini S, Metanis I, Leker RR, Pan K, Dantu V, Baumgartner K, Burton T, von Rennenberg R, Nolte CH, Choi R, MacDonald J, Bavarsad Shahripour R, Guo X, Ghannam M, Almajali M, Samaniego EA, Sanchez S, Rioux B, Zine-Eddine F, Poppe A, Fonseca AC, Fortuna Baptista M, Cruz D, Romoli M, De Marco G, Longoni M, Keser Z, Griffin K, Kuohn L, Frontera J, Amar J, Giles J, Zedde M, Pascarella R, Grisendi I, Nzwalo H, Liebeskind DS, Molaie A, Cavalier A, Kam W, Mac Grory B, Al Kasab S, Anadani M, Kicielinski K, Eltatawy A, Chervak L, Chulluncuy Rivas R, Aziz Y, Bakradze E, Tran TL, Rodrigo Gisbert M, Requena M, Saleh Velez F, Ortiz Gracia J, Muddasani V, de Havenon A, Vishnu VY, Yaddanapudi S, Adams L, Browngoehl A, Ranasinghe T, et alMandel DM, Shu L, Chang C, Jack N, Leon Guerrero CR, Henninger N, Muppa J, Affan M, Ul Haq Lodhi O, Heldner MR, Antonenko K, Seiffge D, Arnold M, Salehi Omran S, Crandall R, Lester E, Lopez Mena D, Arauz A, Nehme A, Boulanger M, Touze E, Sousa JA, Sargento-Freitas J, Barata V, Castro-Chaves P, Brito MT, Khan M, Mallick D, Rothstein A, Khazaal O, Kaufman JE, Engelter ST, Traenka C, Aguiar de Sousa D, Soares M, Rosa S, Zhou LW, Gandhi P, Field TS, Mancini S, Metanis I, Leker RR, Pan K, Dantu V, Baumgartner K, Burton T, von Rennenberg R, Nolte CH, Choi R, MacDonald J, Bavarsad Shahripour R, Guo X, Ghannam M, Almajali M, Samaniego EA, Sanchez S, Rioux B, Zine-Eddine F, Poppe A, Fonseca AC, Fortuna Baptista M, Cruz D, Romoli M, De Marco G, Longoni M, Keser Z, Griffin K, Kuohn L, Frontera J, Amar J, Giles J, Zedde M, Pascarella R, Grisendi I, Nzwalo H, Liebeskind DS, Molaie A, Cavalier A, Kam W, Mac Grory B, Al Kasab S, Anadani M, Kicielinski K, Eltatawy A, Chervak L, Chulluncuy Rivas R, Aziz Y, Bakradze E, Tran TL, Rodrigo Gisbert M, Requena M, Saleh Velez F, Ortiz Gracia J, Muddasani V, de Havenon A, Vishnu VY, Yaddanapudi S, Adams L, Browngoehl A, Ranasinghe T, Dunston R, Lynch Z, Penckofer M, Siegler JE, Mayer S, Willey J, Zubair A, Cheng YK, Sharma R, Marto JP, Mendes Ferreira V, Klein P, Nguyen TN, Asad SD, Sarwat Z, Balabhadra A, Patel S, Secchi T, Martins S, Mantovani G, Kim YD, Krishnaiah B, Elangovan C, Lingam S, Quereshi A, Fridman S, Alvarado A, Khasiyev F, Linares G, Mannino M, Terruso V, Vassilopoulou S, Tentolouris-Piperas V, Martinez Marino M, Carrasco Wall V, Indraswari F, El Jamal S, Liu S, Alvi M, Ali F, Sarvath M, Morsi RZ, Kass-Hout T, Shi F, Zhang J, Sokhi D, Said J, Mongare N, Simpkins A, Gomez R, Sen S, Ghani M, Elnazeir M, Xiao H, Kala N, Khan F, Stretz C, Mohammadzadeh N, Goldstein E, Furie K, Yaghi S. Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection. Stroke 2025. [PMID: 40143807 DOI: 10.1161/strokeaha.124.048215] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 01/15/2025] [Accepted: 03/04/2025] [Indexed: 03/28/2025]
Abstract
BACKGROUND Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals. METHODS This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022. The primary outcome was subsequent ischemic stroke by day 180 after diagnosis. Clinical and imaging variables were compared between those with versus without subsequent ischemic stroke. Significant factors associated with subsequent stroke risk were identified using stepwise Cox regression. Associations between subsequent ischemic stroke risk and antithrombotic therapy type (anticoagulation versus antiplatelets) among patients with identified risk factors were explored using adjusted Cox regression. RESULTS In all, 4023 patients (mean age was 47.4 years; 44.5% were women) were included. By day 180, subsequent ischemic stroke occurred in 5.3% of the cohort. In adjusted Cox regression, factors associated with increased risk of subsequent ischemic stroke were prior history of ischemic stroke (adjusted hazard ratio [aHR], 7.31 [95% CI, 1.61-33.13]; P=0.010), presentation within 7 days from first symptoms (aHR, 3.04 [95% CI, 1.04-8.91]; P=0.043), infarct on baseline imaging (aHR, 9.85 [95% CI, 3.65-26.58]; P<0.001), and occlusive dissection (aHR, 2.34 [95% CI, 1.03-5.34]; P=0.043). Only patients with occlusive dissection demonstrated a reduced risk of subsequent ischemic stroke when treated with anticoagulation versus antiplatelets (aHR, 0.36 [95% CI, 0.16-0.80]; P=0.01). CONCLUSIONS In this post hoc analysis of the STOP-CAD study, several factors associated with subsequent ischemic stroke were identified among patients with CAD. Furthermore, we identified a potential benefit of anticoagulation in patients with CAD with occlusive dissection. These findings require validation by meta-analyses of prior studies to formulate optimal treatment strategies for specific high-risk CAD subgroups.
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Affiliation(s)
- Daniel M Mandel
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Liqi Shu
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Christopher Chang
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Naomi Jack
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | | | - Nils Henninger
- Department of Neurology, University of Massachusetts, Chan Medical School, Worcester, MA (N.H., J.M.)
| | - Jayachandra Muppa
- Department of Neurology, University of Massachusetts, Chan Medical School, Worcester, MA (N.H., J.M.)
| | - Muhammad Affan
- Department of Neurology, University of Minnesota, Minneapolis (M. Affan, O.U.H.L.)
| | - Omair Ul Haq Lodhi
- Department of Neurology, University of Minnesota, Minneapolis (M. Affan, O.U.H.L.)
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)
| | - David Seiffge
- Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)
| | - Marcel Arnold
- Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O., R. Crandall, E.L.)
| | - Ross Crandall
- Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O., R. Crandall, E.L.)
| | - Evan Lester
- Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O., R. Crandall, E.L.)
| | - Diego Lopez Mena
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico (D.L.M., A. Arauz)
| | - Antonio Arauz
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico (D.L.M., A. Arauz)
| | - Ahmad Nehme
- Service de Neurologie, Université Caen Normandie, France (A.N., M.B., E.T.)
| | - Marion Boulanger
- Service de Neurologie, Université Caen Normandie, France (A.N., M.B., E.T.)
| | - Emmanuel Touze
- Service de Neurologie, Université Caen Normandie, France (A.N., M.B., E.T.)
| | - Joao Andre Sousa
- Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., V.B.)
| | | | - Vasco Barata
- Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., V.B.)
| | - Paulo Castro-Chaves
- Department of Internal Medicine, São João University Hospital, Portugal (P.C.-C., M.T.B.)
| | - Maria Teresa Brito
- Department of Internal Medicine, São João University Hospital, Portugal (P.C.-C., M.T.B.)
| | - Muhib Khan
- Department of Neurology, Corewell Health, Grand Rapids, MI (M.K., D.M.)
- Department of Neurology, Mayo Clinic, Rochester, MN (M.K., Z.K., K.G.)
| | - Dania Mallick
- Department of Neurology, Corewell Health, Grand Rapids, MI (M.K., D.M.)
| | - Aaron Rothstein
- Department of Neurology, University of Pennsylvania, Philadelphia (A.R., O.K.)
| | - Ossama Khazaal
- Department of Neurology, University of Pennsylvania, Philadelphia (A.R., O.K.)
| | - Josefin E Kaufman
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, and University Hospital Basel, Switzerland (J.E.K., S.T.E., C.T.)
| | - Stefan T Engelter
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, and University Hospital Basel, Switzerland (J.E.K., S.T.E., C.T.)
| | - Christopher Traenka
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, and University Hospital Basel, Switzerland (J.E.K., S.T.E., C.T.)
| | - Diana Aguiar de Sousa
- Stroke Center, Centro Hospitalar Universitário Lisboa Central, and Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Portugal (D.A.d.S.)
| | - Mafalda Soares
- Department of Neurology, Centro Hospitalar Universitário Lisboa Central, Portugal. (M. Soares)
| | - Sara Rosa
- Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Portugal. (S.R.)
| | - Lily W Zhou
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)
| | - Preet Gandhi
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)
| | - Steven Mancini
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)
| | - Issa Metanis
- Department of Neurology, Hadassah-Hebrew University Medical Center, Israel (I.M., R.R.L.)
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Israel (I.M., R.R.L.)
| | - Kelly Pan
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Vishnu Dantu
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Karl Baumgartner
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Tina Burton
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Regina von Rennenberg
- Department of Neurology with Experimental Neurology, Charite Universitätsmedizin-Berlin and Center for Stroke Research, Germany (R.v.R., C.H.N.)
| | - Christian H Nolte
- Department of Neurology with Experimental Neurology, Charite Universitätsmedizin-Berlin and Center for Stroke Research, Germany (R.v.R., C.H.N.)
| | - Richard Choi
- Department of Neurosciences, ChristianaCare, Newark, DE (R. Choi, J.M.)
| | - Jason MacDonald
- Department of Neurosciences, ChristianaCare, Newark, DE (R. Choi, J.M.)
| | | | - Xiaofan Guo
- Department of Neurology, Loma Linda University, CA (X.G.)
| | - Malik Ghannam
- Department of Neurology, University of Iowa (M. Ghannam, M. Almajali, E.A.S., S. Sanchez)
| | - Mohammad Almajali
- Department of Neurology, University of Iowa (M. Ghannam, M. Almajali, E.A.S., S. Sanchez)
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa (M. Ghannam, M. Almajali, E.A.S., S. Sanchez)
| | - Sebastian Sanchez
- Department of Neurology, University of Iowa (M. Ghannam, M. Almajali, E.A.S., S. Sanchez)
| | - Bastien Rioux
- Department of Neurosciences, Université de Montréal, Canada (B.R., F.Z.-E., A.P.)
| | - Faycal Zine-Eddine
- Department of Neurosciences, Université de Montréal, Canada (B.R., F.Z.-E., A.P.)
| | - Alexandre Poppe
- Department of Neurosciences, Université de Montréal, Canada (B.R., F.Z.-E., A.P.)
| | - Ana Catarina Fonseca
- Department of Neurology, Hospital de Santa Maria, Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Portugal (A.C.F., M.F.B., D.C.)
| | - Maria Fortuna Baptista
- Department of Neurology, Hospital de Santa Maria, Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Portugal (A.C.F., M.F.B., D.C.)
| | - Diana Cruz
- Department of Neurology, Hospital de Santa Maria, Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Portugal (A.C.F., M.F.B., D.C.)
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Italy (M. Romoli, G.D.M., M.L.)
| | - Giovanna De Marco
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Italy (M. Romoli, G.D.M., M.L.)
| | - Marco Longoni
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Italy (M. Romoli, G.D.M., M.L.)
| | - Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN (M.K., Z.K., K.G.)
| | - Kim Griffin
- Department of Neurology, Mayo Clinic, Rochester, MN (M.K., Z.K., K.G.)
| | - Lindsey Kuohn
- Department of Neurology, NYU Langone Health (L.K., J.F.)
| | | | - Jordan Amar
- Department of Neurology, Washington University, Saint Louis, MO (J.A., J.G.)
| | - James Giles
- Department of Neurology, Washington University, Saint Louis, MO (J.A., J.G.)
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy. (M.Z., I.G.)
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy. (R.P.)
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy. (M.Z., I.G.)
| | - Hipolito Nzwalo
- Department of Internal Medicine, Centro Hospital Universitario do Algarve, Faro, Portugal (H.N.)
| | - David S Liebeskind
- Department of Neurology, University of California at Los Angeles (D.S.L., A.M.)
| | - Amir Molaie
- Department of Neurology, University of California at Los Angeles (D.S.L., A.M.)
| | - Annie Cavalier
- Department of Neurology, Duke University, Durham, NC (A.C., B.M.G.)
| | - Wayneho Kam
- Department of Neurology, University of North Carolina Health Rex, Raleigh (W.K.)
| | - Brian Mac Grory
- Department of Neurology, Duke University, Durham, NC (A.C., B.M.G.)
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston. (S.A.K., M. Anadani)
| | - Mohammad Anadani
- Department of Neurology, Medical University of South Carolina, Charleston. (S.A.K., M. Anadani)
| | - Kimberly Kicielinski
- Department of Neurosurgery, Medical University of South Carolina, Charleston. (K.K.)
| | - Ali Eltatawy
- Department of Neurology, University of Cincinnati Medical Center, OH (A.E., L.C., R.C.R., Y.A.)
| | - Lina Chervak
- Department of Neurology, University of Cincinnati Medical Center, OH (A.E., L.C., R.C.R., Y.A.)
| | | | - Yasmin Aziz
- Department of Neurology, University of Cincinnati Medical Center, OH (A.E., L.C., R.C.R., Y.A.)
| | - Ekaterina Bakradze
- Department of Neurology, University of Alabama at Birmingham (E.B., T.L.T.)
| | - Thanh Lam Tran
- Department of Neurology, University of Alabama at Birmingham (E.B., T.L.T.)
| | - Marc Rodrigo Gisbert
- Department of Neurology, University Hospital Vall d'Hebron, Barcelona, Spain (M.R.G., M. Requena)
| | - Manuel Requena
- Department of Neurology, University Hospital Vall d'Hebron, Barcelona, Spain (M.R.G., M. Requena)
| | | | | | - Varsha Muddasani
- Department of Neurology, Einstein-Jefferson Healthcare Network, Philadelphia, PA (V.M.)
| | - Adam de Havenon
- Department of Neurology, Yale New Haven Hospital, CT (A.d.H., A.Z., Y.K.C., R.S.)
- Department of Neurology, University of Utah, Salt Lake City (A.d.H.)
| | | | - Sridhara Yaddanapudi
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA (S. Yaddanapudi, L.A., A. Browngoehl)
| | - Latasha Adams
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA (S. Yaddanapudi, L.A., A. Browngoehl)
| | - Abigail Browngoehl
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA (S. Yaddanapudi, L.A., A. Browngoehl)
| | - Tamra Ranasinghe
- Department of Neurology, Wake Forest Medical Center, NC (T.R., R.D., Z.L.)
| | - Randy Dunston
- Department of Neurology, Wake Forest Medical Center, NC (T.R., R.D., Z.L.)
| | - Zachary Lynch
- Department of Neurology, Wake Forest Medical Center, NC (T.R., R.D., Z.L.)
| | - Mary Penckofer
- Department of Neurology, Cooper University, Camden, NJ (M.P., J.E.S.)
| | - James E Siegler
- Department of Neurology, Cooper University, Camden, NJ (M.P., J.E.S.)
| | - Silvia Mayer
- Department of Neurology, Columbia University Medical Center, New York (S. Mayer, J.W.)
| | - Joshua Willey
- Department of Neurology, Columbia University Medical Center, New York (S. Mayer, J.W.)
| | - Adeel Zubair
- Department of Neurology, Yale New Haven Hospital, CT (A.d.H., A.Z., Y.K.C., R.S.)
| | - Yee Kuang Cheng
- Department of Neurology, Yale New Haven Hospital, CT (A.d.H., A.Z., Y.K.C., R.S.)
| | - Richa Sharma
- Department of Neurology, Yale New Haven Hospital, CT (A.d.H., A.Z., Y.K.C., R.S.)
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal (J.P.M., V.M.F.)
| | - Vítor Mendes Ferreira
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal (J.P.M., V.M.F.)
| | - Piers Klein
- Department of Neurology, Boston Medical Center, MA (P.K., T.N.N.)
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, MA (P.K., T.N.N.)
| | - Syed Daniyal Asad
- Department of Neurology, Hartford Hospital, CT (S.D.A., Z.S., A. Balabhadra, S.P.)
| | - Zoha Sarwat
- Department of Neurology, Hartford Hospital, CT (S.D.A., Z.S., A. Balabhadra, S.P.)
| | - Anvesh Balabhadra
- Department of Neurology, Hartford Hospital, CT (S.D.A., Z.S., A. Balabhadra, S.P.)
| | - Shivam Patel
- Department of Neurology, Hartford Hospital, CT (S.D.A., Z.S., A. Balabhadra, S.P.)
| | - Thais Secchi
- Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, Brazil (T.S.)
| | - Sheila Martins
- Department of Neurology, Hospital de Clínicas de Porto Alegre, Brazil (S. Martins, G.M.)
| | - Gabriel Mantovani
- Department of Neurology, Hospital de Clínicas de Porto Alegre, Brazil (S. Martins, G.M.)
| | - Young Dae Kim
- Department of Neurology, Yonsei University, Seoul, South Korea (Y.D.K.)
| | - Balaji Krishnaiah
- Department of Neurology, University of Tennessee at Memphis (B.K., C.E.)
| | - Cheran Elangovan
- Department of Neurology, University of Tennessee at Memphis (B.K., C.E.)
| | - Sivani Lingam
- Department of Neurology, Kansas University Medical Center (S. Lingam, A.Q.)
| | - Abid Quereshi
- Department of Neurology, Kansas University Medical Center (S. Lingam, A.Q.)
| | - Sebastian Fridman
- Department of Neurology, Western Ontario University, London, Canada (S.F., A. Alvarado)
| | - Alonso Alvarado
- Department of Neurology, Western Ontario University, London, Canada (S.F., A. Alvarado)
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University, MO (F. Khasiyev, G.L.)
| | - Guillermo Linares
- Department of Neurology, Saint Louis University, MO (F. Khasiyev, G.L.)
| | - Marina Mannino
- Department of Neurology and Stroke Unit, AOOR Villa Sofia-V. Cervello, Palermo, Italy (M.M., V.T.)
| | - Valeria Terruso
- Department of Neurology and Stroke Unit, AOOR Villa Sofia-V. Cervello, Palermo, Italy (M.M., V.T.)
| | - Sofia Vassilopoulou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Greece (S.V., V.T.-P.)
| | | | | | - Victor Carrasco Wall
- Department of Neurology, Centro Médico Nacional Siglo XXI IMSS, Mexico (M.M.M., V.C.W.)
| | | | - Sleiman El Jamal
- Department of Neurology, The Miriam Hospital, Providence, RI (F.I., S.E.J.)
| | - Shilin Liu
- Department of Neurocritical Care Unit, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China (S. Liu)
| | - Muhammad Alvi
- Department of Neurology, West Virginia University (M. Alvi, F.A., M. Sarvath)
| | - Farman Ali
- Department of Neurology, West Virginia University (M. Alvi, F.A., M. Sarvath)
| | - Mohammed Sarvath
- Department of Neurology, West Virginia University (M. Alvi, F.A., M. Sarvath)
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, IL (R.Z.M., T.K.-H.)
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, IL (R.Z.M., T.K.-H.)
| | - Feina Shi
- Department of Neurology, Sir Run Run Shaw Hospital of Zhejiang University Medical School, Hangzhou, China (F.S., J.Z.)
| | - Jinhua Zhang
- Department of Neurology, Sir Run Run Shaw Hospital of Zhejiang University Medical School, Hangzhou, China (F.S., J.Z.)
| | - Dilraj Sokhi
- Department of Neurology, Aga Khan University, Nairobi, Kenya (D. Sokhi, J.S., N. Mongare)
| | - Jamil Said
- Department of Neurology, Aga Khan University, Nairobi, Kenya (D. Sokhi, J.S., N. Mongare)
| | - Newnex Mongare
- Department of Neurology, Aga Khan University, Nairobi, Kenya (D. Sokhi, J.S., N. Mongare)
| | - Alexis Simpkins
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA (A.S., R.G., S. Sen)
| | - Roberto Gomez
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA (A.S., R.G., S. Sen)
| | - Shayak Sen
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA (A.S., R.G., S. Sen)
| | - Mohammad Ghani
- Department of Neurology, University of Louisville (M. Ghani, M.E.)
| | - Marwa Elnazeir
- Department of Neurology, University of Louisville (M. Ghani, M.E.)
| | - Han Xiao
- Department of Economics, University of California Santa Barbara (H.X.)
| | - Narendra Kala
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Farhan Khan
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Christoph Stretz
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Nahid Mohammadzadeh
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Eric Goldstein
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Karen Furie
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
| | - Shadi Yaghi
- Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)
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Hopf-Jensen S, Bajwa N, Müller-Hülsbeck S. Endovascular Treatment of Carotid Artery Dissection Caused by Eagle's Syndrome : Case Report. Clin Neuroradiol 2025; 35:197-201. [PMID: 38949685 DOI: 10.1007/s00062-024-01433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Affiliation(s)
- S Hopf-Jensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, DIAKO Hospital Flensburg, Knutstraße 1, 24939, Flensburg, Germany.
| | - N Bajwa
- Department of Neurosurgery, BG-Hospital Hamburg, Bergedorfer Straße 10, 21033, Hamburg-Boberg, Germany
| | - S Müller-Hülsbeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, DIAKO Hospital Flensburg, Knutstraße 1, 24939, Flensburg, Germany
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Xiao S, Zhang J, Wang L, Zhang H. Analysis of a delayed diagnosis of carotid artery aneurysm presenting as a parapharyngeal space infection. EAR, NOSE & THROAT JOURNAL 2025; 104:198S-201S. [PMID: 36189632 DOI: 10.1177/01455613221113811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is very rare for extracranial carotid artery dissection to present as a carotid pseudoaneurysm. A delayed diagnosis and delayed treatment will lead to rupture of carotid pseudoaneurysm and massive hemorrhage and death. In this paper, we reviewed the progress of the disease in one patient and reviewed the relevant literature reports to understand the characteristics of the disease. The patient had two consultations within the otolaryngology department. The patient later showed signs of infection in the parapharyngeal space and then died of an aneurysmal rupture and massive hemorrhage.
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Affiliation(s)
- Shufen Xiao
- Departments of Otorhinolaryngology-Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang, China
| | - Juan Zhang
- Department of Pharmacy, The Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
| | - Ling Wang
- Departments of Otorhinolaryngology-Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang, China
| | - Hong Zhang
- Departments of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Hospital of Hebei University of Engineering, Handan, China
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Egashira S, Kunisawa S, Koga M, Ihara M, Tsuruta W, Uesaka Y, Fushimi K, Toda T, Imanaka Y. Safety and outcomes of intravenous thrombolysis in acute ischemic stroke with intracranial artery dissection. Int J Stroke 2025:17474930251317326. [PMID: 39834052 DOI: 10.1177/17474930251317326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) related to underlying intracranial artery dissection (IAD) poses potential risks, including the exacerbation of intramural hematoma and the rupture of the dissected arterial wall. However, the safety of IVT in this specific population remains uncertain. AIMS This study aimed to assess whether IAD is associated with an increased risk of intracranial hemorrhage (ICH) following IVT and to evaluate its impact on functional outcomes. METHODS This retrospective matched-pair cohort study used a nationwide inpatient database that includes discharge abstracts and administrative claims data in Japan. We included adult patients with AIS treated with IVT between July 2010 and July 2024. We excluded patients with carotid or vertebral artery dissections due to difficulties distinguishing between intracranial and extracranial involvement, those lacking premorbid/discharge modified Rankin Scale (mRS) data, and those who received intra-arterial thrombolysis. Patients with IAD were matched 1:4 with non-IAD controls based on age, sex, premorbid mRS, endovascular treatment (EVT), and teaching hospital status. We assessed ICH, functional independence at discharge (mRS = 0-2), and in-hospital mortality using multivariable logistic regression with generalized estimating equations to account for clustering within matched pairs, adjusting for age, sex, premorbid mRS, body mass index, smoking history, hypertension, diabetes mellitus, atrial fibrillation, coagulopathy, Japan Coma Scale, EVT, and teaching hospital status. RESULTS Of 83,139 patients with AIS treated with IVT, 242 (0.3%) had underlying IAD (median age = 54 (46-67) years; 34% women). These patients were matched with 968 non-IAD controls. IAD was associated with a higher risk of ICH (odds ratio (OR) = 3.18; 95% confidence interval (CI) = 1.26-8.06) and a lower likelihood of functional independence at discharge (OR = 0.51; 95% CI = 0.37-0.72), but not with increased in-hospital mortality (OR = 1.09; 95% CI = 0.50-2.38). CONCLUSION Patients with underlying IAD may face an increased risk of ICH and a reduced chance of functional recovery following IVT compared to those without.
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Affiliation(s)
- Shuhei Egashira
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | | | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Institute of Science Tokyo Graduate School, Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Health Security System, Center for Health Security, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Doukhi D, Debette S, Mawet J. Headaches attributed to cranial and cervical artery dissections. J Headache Pain 2025; 26:28. [PMID: 39915731 PMCID: PMC11800537 DOI: 10.1186/s10194-025-01958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 01/21/2025] [Indexed: 02/09/2025] Open
Abstract
Headache is a common neurological symptom, often leading to the investigation of secondary causes, including cerebrovascular conditions such as cranial and cervical artery dissection (CCAD). CCAD, a significant cause of stroke in younger adults, commonly presents with headache or neck pain, isolated or accompanied by neurological deficits, and may mimic primary headache disorders, complicating timely diagnosis. This review explores the role of headache in CCAD, specifically addressing headache as an initial presentation, its evolution post-dissection, and as a potential risk factor of CCAD. By synthesizing current evidence, the review aims to improve early detection and clinical management of CCAD in headache patients.
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Affiliation(s)
- Diana Doukhi
- Emergency Headache Center (Centre d'Urgences Céphalées), Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.
- FHU NeuroVasc, Paris, France.
- Université Paris Cité, Paris, France.
| | - Stéphanie Debette
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, F-33000, France
- Department of Neurology, Institute for Neurodegenerative Diseases, Bordeaux University Hospital, Bordeaux, F-33000, France
| | - Jérome Mawet
- Emergency Headache Center (Centre d'Urgences Céphalées), Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
- FHU NeuroVasc, Paris, France
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7
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Engelter ST, Enz LS, Ravanelli F, Kaufmann JE, Gensicke H, Schaedelin S, Luft AR, Globas C, Goeggel-Simonetti B, Fischer U, Strambo D, Kägi G, Nedeltchev K, Kahles T, Kellert L, Rosenbaum S, von Rennenberg R, Brehm A, Seiffge D, Renaud S, Brandt T, Sarikaya H, Zietz A, Wischmann J, Polymeris AA, Fischer S, Bonati LH, De Marchis GM, Peters N, Nolte CH, Christensen H, Wegener S, Psychogios MN, Arnold M, Lyrer P, Traenka C. The 6-months follow-up of the TREAT-CAD trial: Aspirin versus anticoagulation for stroke prevention in patients with cervical artery dissection. Eur Stroke J 2025:23969873251315362. [PMID: 39910883 PMCID: PMC11803590 DOI: 10.1177/23969873251315362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 01/05/2025] [Indexed: 02/07/2025] Open
Abstract
INTRODUCTION Cervical artery dissection is a major cause of stroke in the young. The optimal choice and duration of antithrombotic treatment for stroke prevention are debated, particularly beyond 3 months after symptom onset. PATIENTS AND METHODS TREAT-CAD (TREATment of Cervical Artery Dissection) was a randomized controlled trial with blinded outcome assessment comparing non-inferiority of aspirin to anticoagulation (Vitamin-K-antagonists) in participants with symptomatic, Magnetic-Resonance-(MR)-imaging-verified cervical artery dissection. TREAT-CAD could not establish non-inferiority of aspirin to anticoagulation at 3 months. Thereafter participants could continue antithrombotic medication and obtained a standardized assessment of clinical and MR-Imaging outcomes between 3 and 6 months. As crossover to the other treatment arm was possible, we performed an as-treated analysis as main analysis. The main outcomes were new clinical (ischemic stroke, intracranial/major extracranial bleeding, or death) and new MR-Imaging outcomes (ischemic or hemorrhagic brain lesions). RESULTS Among the 122 participants in the as-treated analysis, 3/93 (3.2%) aspirin-treated participants had new clinical (n = 1) and MRI-outcomes (n = 2) between 3 and 6 months while 1/29 (3.4%) anticoagulated participants had an MRI-outcome (n = 1). All outcome events were hemorrhagic while ischemic events were absent. No deaths occurred. This yields an absolute difference of 0.2% (95% CI -8.0% to 7.5%, p = 1.0). DISCUSSION AND CONCLUSION During the extended follow-up period of a controlled randomized trial comparing aspirin to anticoagulation in cervical artery dissection, outcomes between 3 and 6 months after randomization occurred rarely, similarly often in both groups and were exclusively hemorrhagic events. Thus, studies balancing benefits versus harms of antithrombotic treatment beyond 3 months are warranted. Registration: ClinicalTrials.gov: NCT02046460. https://clinicaltrials.gov/ct2/show/NCT02046460.
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Affiliation(s)
- Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Lukas S Enz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Flavia Ravanelli
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Josefin E Kaufmann
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Christoph Globas
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Barbara Goeggel-Simonetti
- Department of Neuropediatrics, Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital, Bellinzona
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Davide Strambo
- Stroke Center, Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Georg Kägi
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Neurology and Stroke Center, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Neurology, University of Bern, Bern, Switzerland
| | - Timo Kahles
- Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Sverre Rosenbaum
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Regina von Rennenberg
- Center for Stroke Research Berlin (CSB), Charite-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Alex Brehm
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - David Seiffge
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Susanne Renaud
- Division of Neurology and Stroke Unit, Neuchâtel Hospital Network, Neuchâtel, Switzerland
| | - Tobias Brandt
- Swiss National Accident Insurance Fund SUVA, Lucerne, Switzerland
| | - Hakan Sarikaya
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Johannes Wischmann
- Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sandro Fischer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Christian H Nolte
- Center for Stroke Research Berlin (CSB), Charite-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charite-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charite, (BIH), Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Susanne Wegener
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | | | - Marcel Arnold
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
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Xeros HK, Griffin KJ, Harmsen WS, Lanzino G, Brown RD, Keser Z. Epidemiology of traumatic cervical artery dissections. Clin Neurol Neurosurg 2025; 249:108688. [PMID: 39675148 DOI: 10.1016/j.clineuro.2024.108688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/19/2024] [Accepted: 12/08/2024] [Indexed: 12/17/2024]
Abstract
INTRODUCTION Unlike spontaneous cervical artery dissection (CeAD), the incidence of CeAD after a major trauma is not well characterized. This population-based observational study investigates the epidemiology and natural history of traumatic cervical artery dissection (CeADs) using data from the Rochester Epidemiology Project (REP) in Olmsted County, USA. METHODS The REP system database has a high likelihood of complete case ascertainment and comparable demographics (age, sex) to the US population. After the initial screening of the database with ICD-based codes for carotid and vertebral dissections, meticulous review was performed to select patients with CeAD due to major trauma. We used Poisson regression to assess the association of age, sex, and time-period using crude incidence rates. RESULTS Analyzing cases from 2002 to 2020, we identified 21 patients with traumatic CeAD, noting a significant 3.5-fold increase in incidence from 2002 to 2011-2012-2020 (0.37-1.29 per 100,000 person-years, p = 0.005). Only 23.8 % of cases experienced traumatic CeAD-related cerebral infarction. No patients received acute reperfusion therapies. Antithrombotic treatment predominantly involved single antiplatelet therapy (47.6 %) with aspirin. However, increasing use of dual antiplatelet therapy (11.8 %) along with declining use of anticoagulation (17.6 %) was also noted over time. We observed no recurrent strokes, dissections, or de-novo pseudoaneurysms. at the final follow-up. CONCLUSION The population-based incidence of traumatic CeAD is on the rise, potentially due to an increased screening in real-life practice leading to improved identification of cases that may have otherwise gone unrecognized. Our study also shows that traumatic CeADs tend to have a favorable prognosis.
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Affiliation(s)
- Helena K Xeros
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.
| | - Kim J Griffin
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - William S Harmsen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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9
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Garner M. [Spontaneous craniocervical dissection]. RADIOLOGIE (HEIDELBERG, GERMANY) 2025; 65:100-109. [PMID: 39792242 DOI: 10.1007/s00117-024-01399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2024] [Indexed: 01/12/2025]
Abstract
PERFORMANCE Spontaneous dissections of the cerebral arteries are among the leading causes of stroke in young adults. They result from hemorrhage into the outer layers of the arterial wall, which can lead to stenosis or even complete vessel occlusion. Clinical presentations vary, ranging from localized pain to cerebral ischemic complications. Early recognition of dissection warning signs and diagnosis through imaging is crucial due to the high risk of recurrent transient ischemic attack (TIA) or stroke within the first two weeks following a dissection, necessitating immediate therapeutic or prophylactic intervention. ACHIEVEMENTS Magnetic resonance imaging (MRI) is the imaging modality of choice, as it can reliably visualize all characteristic features of dissection. Typically, thin-slice, fat-saturated 3D black-blood sequences are sufficient to detect the pathognomonic intramural hematoma. PRACTICAL RECOMMENDATIONS Acute treatment and secondary prevention depend on the extent of neurological deficits, the location and size of the dissection, any sequelae, concomitant pathologies, and risk factors. In most cases, spontaneous vascular recanalization or regression of vessel stenosis occurs within several months due to resorption of the mural hematoma.
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Affiliation(s)
- Malvina Garner
- Klinik für diagnostische und interventionelle Neuroradiologie, Universitätskliniken des Saarlandes, Kirrberger Str., 66421, Homburg Saar, Deutschland.
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Thomas L, Fowler M, Marsh L, Chu K, Muller C, Wong A. Validation of a diagnostic support tool for early recognition of cervical arterial dissection in primary care. Clin Neurol Neurosurg 2024; 247:108627. [PMID: 39504686 DOI: 10.1016/j.clineuro.2024.108627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 11/01/2024] [Accepted: 11/02/2024] [Indexed: 11/08/2024]
Abstract
BACKGROUND Cervical arterial dissection (CeAD) is a leading cause of stroke in young adults with an early presentation often mimicking musculoskeletal pain. Currently, no validated tests exist and CAD may be missed. A diagnostic support tool could help guide urgent referral for imaging, when to monitor, or when safe to proceed with treatment, and ultimately help stroke prevention. OBJECTIVES To validate a 4-criteria diagnostic support tool for early recognition of CeAD in primary care, to refine tool descriptors as needed, and propose optimal cut-offs for clinical application. DESIGN Prospective observational study METHOD: Participants with radiologically confirmed CeAD and controls without CeAD were identified from adults >18 years presenting to a tertiary metropolitan hospital with initial diagnosis of headache or neck pain. All were scored with criteria out of7 (acute onset pain [2], recent trauma/infection [1], neurological features [2], age <55 years [2]). Diagnostic values were calculated to determine cut offs and the tool was refined based on the analysis. RESULTS Thirty participants with CeAD and 261 controls with non-CeAD causes of headache and neck pain were included. The diagnostic support tool was an 'excellent' predictor of CeAD (AUC 0.83) but demonstrated poor specificity. Refining the tool to 'acute/sudden onset' [1], 'unusual/unfamiliar headache/neck pain' [1], recent trauma/infection [1] and neurological features ≥2 [1], scored out of 4, showed 100 % sensitivity and 74 % specificity to detect CeAD at a cut-off of 3/4 (AUC 0.87). CONCLUSIONS The refined tool shows acceptable clinical utility at a cut-off ≥3, where referral for vascular imaging is recommended. Further validation in Emergency and primary care is needed.
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Affiliation(s)
- L Thomas
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
| | - M Fowler
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - L Marsh
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - K Chu
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Claire Muller
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - A Wong
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia
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11
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Gabet A, Grave C, Aboyans V, Lailler G, Tuppin P, Kownator S, Kantor B, de Freminville JB, Emmerich J, Blacher J, Olié V. Epidemiology of aortic and peripheral arterial diseases in France. Arch Cardiovasc Dis 2024; 117:738-750. [PMID: 39638732 DOI: 10.1016/j.acvd.2024.10.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 10/10/2024] [Accepted: 10/15/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Peripheral arterial diseases (PADs) account for much of the morbidity and hospitalizations experienced by patients with cardiovascular disease. Epidemiological data on these diseases are lacking in France. AIMS To describe the epidemiology of aortic diseases (aneurysm and dissection) and PADs in France in 2022. METHODS This study was carried out using the National Health Data System. Patients hospitalized with these diseases in 2022 and patients who died from these diseases in 2021 were selected. The prevalence of aortic diseases and PADs among people alive on 1 January 2023 was estimated from previous hospitalizations and registered long-term disease. Mortality and secondary treatment were examined in the year following hospitalization. RESULTS In 2022, there were 68,702 patients hospitalized in France for a lower extremity artery disease (LEAD), 9083 for abdominal aortic aneurysm and 9027 for dissection or aneurysm of a medium-sized artery (standardized rates: 112.6, 15.0 and 15.5 per 100,000, respectively). The standardized prevalences of these diseases were 1.23%, 0.17% and 0.22% of adults, respectively. Regional and social disparities in the age-standardized rates of hospitalized patients were observed. One-year mortality ranged from approximately 11% for patients hospitalized for thoracic aortic aneurysm or medium-sized artery dissection/aneurysm to 27.0% for aortic dissection. The proportions of patients hospitalized due to LEAD who were being treated with antiplatelet or lipid-lowering drugs 1 year after the index hospitalization were 86.6% and 75.9%, respectively. CONCLUSION The burden of aortic diseases and PADs is considerable in France and mortality remains high for ruptured aortic aneurysm and aortic dissection.
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Affiliation(s)
- Amélie Gabet
- Santé Publique France, 94410 Saint-Maurice, France.
| | | | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, 87000 Limoges, France; EpiMaCT, INSERM 1094 & IRD 270, Limoges University, 87032 Limoges, France
| | | | | | | | - Béata Kantor
- Paris public hospitals (AP-HP), Hôtel-Dieu Hospital, 75004 Paris, France
| | - Jean-Baptiste de Freminville
- Department of Cardiology and Vascular Medicine, Trousseau Hospital, Tours Regional University Hospital, 37044 Tours Cedex, France; Department of Vascular Medicine, Georges Pompidou European Hospital, Paris public hospitals, Paris Cité University, 75015 Paris, France
| | | | - Jacques Blacher
- Paris public hospitals (AP-HP), Hôtel-Dieu Hospital, 75004 Paris, France
| | - Valérie Olié
- Santé Publique France, 94410 Saint-Maurice, France
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12
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Zhao M, Zhong X, Du J, Li L, Wang J, Wang H. Association of diabetes and white blood cell count with stroke in patients with carotid artery dissection. BMC Neurol 2024; 24:350. [PMID: 39289622 PMCID: PMC11406767 DOI: 10.1186/s12883-024-03856-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 09/09/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Carotid artery dissection is an important cause of stroke. However, the predictors of ischemic stroke in patients with carotid artery dissection are controversial. The study aimed to analyze the predictors of ischemic stroke in patients with carotid artery dissection through retrospective medical records. METHODS Data of discharged patients diagnosed with carotid artery dissection during 2019-2023 were retrospectively collected. Based on the occurrence of ischemic stroke, the patients were divided into the ischemic stroke or non-ischemic stroke groups. Based on the results of univariate analyses, variables with an associated P value < 0.05 were introduced into the multivariable logistic regression analysis. . RESULTS A total of 165 patients were included in the study, with an average age of 55.00 (48.00, 66.00) years, including 86 patients with internal carotid artery dissection and 79 patients with vertebral artery dissection. Ischemic stroke occurred in 69 patients with carotid artery dissection. Multivariate logistic regression analysis indicated that diabetes (odds ratio [OR]: 3.144, 95% confidence interval [CI]: 1.552-6.508, P<0.002) and high white blood cells count (OR: 1.157, 95% CI: 1.02-1.327,P = 0.028) were related to the incidence of ischemic stroke in patients with carotid artery dissection. CONCLUSION Ischemic stroke caused by carotid artery dissection causes severe damage to the nervous system. This study found that diabetes and high white blood cells count were associated with the incidence of ischemic stroke in patients with carotid artery dissection. Therefore, monitoring and controlling blood glucose levels and infections is essential in patients with carotid artery dissection to reduce the incidence of stroke.
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Affiliation(s)
- Meng Zhao
- Intensive care unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zheng Zhou, China
| | - Xuemin Zhong
- Neurology, ChengDu Second People's Hospital, Chengdu, China
| | - Jiaxiu Du
- Intensive care unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zheng Zhou, China
| | - Li Li
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Wang
- Neurology, ChengDu Second People's Hospital, Chengdu, China.
| | - Hongyu Wang
- Intensive care unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zheng Zhou, China.
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13
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Evans A, Rehan J. Separate Spontaneous Extracranial and Intracranial Left Internal Carotid Artery Dissections Causing an Acute Ischemic Stroke: A Case Report. Cureus 2024; 16:e69777. [PMID: 39429289 PMCID: PMC11490940 DOI: 10.7759/cureus.69777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2024] [Indexed: 10/22/2024] Open
Abstract
We present a case of a 45-year-old man who suffered simultaneous intracranial and extracranial dissections within the same artery, ultimately leading to a large left-sided ischemic stroke. To our knowledge, this is the only reported case of multiple dissections of the same head or neck (cervicocephalic) artery. We discuss the current evidence and literature around the characteristics of patients who experience multiple cervicocephalic artery dissections.
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Affiliation(s)
- Andrew Evans
- Stroke Medicine, King's Mill Hospital, Sutton-in-Ashfield, GBR
| | - Jahanzeb Rehan
- Stroke Medicine, King's Mill Hospital, Sutton-in-Ashfield, GBR
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14
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Zhang Y, Zhang Y, Froehlich K, Mrochen A, Muehlen I, Lang S, Lehmann S, Gerner ST, Huttner HB, Schwab S, He L, Bobinger T. Individual participant data analysis comparing acute stroke patients with anterior versus posterior circulation dissections. Clin Neurol Neurosurg 2024; 243:108381. [PMID: 38870671 DOI: 10.1016/j.clineuro.2024.108381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/01/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Cervical artery dissection (CAD) is a relevant etiology of transient ischemic attacks and strokes. Several trials explored the significance of specific antithrombotic treatments, i.e. oral anticoagulation (OAC) versus antiplatelet treatment (APT), on recurrent ischemic complications and clinical outcomes. As overall incidence rates of complications were low there is still controversy which antithrombotic treatment should be used. However, up to now there has been no systematic investigation among CAD-patients with ischemic stroke specifically comparing clinical course and outcome of patients with anterior versus posterior CAD. METHODS We performed an individual participant data analysis of patients with CAD and ischemic stroke. Over a five-year period we pooled data from three sites (i.e. West China Hospital, Chengdu, China as well as Erlangen and Giessen University Hospitals, Germany) and enrolled patients with CAD-associated ischemic stroke. Patient demographics, clinical and in-hospital measures as well as radiological data were retrieved from institutional databases. Clinical follow-up was over 6 months and included data on recurrent ischemic strokes and hemorrhages as well as clinical functional outcome assessed by the modified Rankin Scale dichotomized into favourable (mRS=0-2) and unfavourable. RESULTS A total of 203 patients with CAD were included of which n=112 had anterior and n=91 had posterior CAD. Patients with posterior CAD were younger (46.0 vs. 41.0 y; p<0.001) than patients with anterior CAD and showed less often arterial hypertension. (42.0 % vs. 28.6 %; p<0.048). Antithrombotic treatment with APT and OAC was similarily distributed among patients with anterior and posterior CAD and not significantly differently related to ischemic or hemorrhagic complications during follow-up (all p=n.s.). Main difference between Chinese and German patients were mode of antithrombotic treatment consisting predominantly of APT in China compared to OAC in Germany. Functional outcome overall was good, yet worse in patients with anterior CAD compared to posterior CAD (80.2 % favorable in anterior CAD vs. 92.2 % in posterior CAD (p=0.014). CONCLUSION This study provides evidence that anterior and posterior CAD show baseline imbalances regarding age and comorbidity which may affect clinical outcome. There are no signals of superiority or harm of any specific mode of antithrombotic treatment nor relevant discrepancies in clinical outcome among Chinese and German CAD-associated stroke patients.
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Affiliation(s)
- Yanan Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Kilian Froehlich
- Department of Neurology, Friedrich-Alexander University Erlangen (FAU), Erlangen, Germany
| | - Anne Mrochen
- Department of Neurology, Friedrich-Alexander University Erlangen (FAU), Erlangen, Germany
| | - Iris Muehlen
- Department of Neuroradiology, Friedrich-Alexander University Erlangen (FAU), Erlangen, Germany
| | - Stefan Lang
- Department of Neuroradiology, Friedrich-Alexander University Erlangen (FAU), Erlangen, Germany
| | - Sophie Lehmann
- Department of Neurology, Justus-Liebig-University Hospital Giessen, Germany
| | - Stefan T Gerner
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Neurology, Justus-Liebig-University Hospital Giessen, Germany
| | - Hagen B Huttner
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Neurology, Justus-Liebig-University Hospital Giessen, Germany.
| | - Stefan Schwab
- Department of Neurology, Friedrich-Alexander University Erlangen (FAU), Erlangen, Germany
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Tobias Bobinger
- Department of Neurology, Friedrich-Alexander University Erlangen (FAU), Erlangen, Germany
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15
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Jia X, Zhu Y. Surgical treatment of one traumatic carotid artery dissection: A case report and review of the literature. Medicine (Baltimore) 2024; 103:e39084. [PMID: 39058866 PMCID: PMC11272348 DOI: 10.1097/md.0000000000039084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Dissection of the cervical arteries is the most commonly identified cause of stroke in young patients. This report helps to investigate the etiology, diagnosis, and treatment of cervical artery dissection (CAD). PATIENT CONCERNS A 40-year-old female presented with a 3-week history of right carotid artery dissection due to a fall. The patient was admitted to the local hospital 3 weeks ago with a right neck impingement after a fall, and presented with right neck pain. The local hospital CT scan showed a dissection of the middle segment of the right common carotid artery. DIAGNOSES The patient clinical manifestations and imaging tests confirmed that right carotid artery dissection. INTERVENTIONS Medical treatment with antiplatelet failed, and the CT scan showed progression of dissection. Carotid endarterectomy (CEA) was performed, and the prognosis is good. OUTCOMES This patient was followed up at 1 and 6 months after the operation, CT scan showed the original stenotic vessels returned to standard diameter. LESSONS Diagnosis of CAD mainly depends on clinical manifestations and imaging. we recommend that clinicians can prescribe either anticoagulants or antiplatelet therapy. CAD can be effectively treated by surgical reconstruction, if medical treatment with anticoagulation or antiplatelet fails or if carotid aneurysms and/or high-grade carotid stenosis persisted or have newly developed.
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Affiliation(s)
- Xiaojian Jia
- Department of Vascular Surgery, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yuefeng Zhu
- Department of Vascular Surgery, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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16
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Salih M, Taussky P, Ogilvy CS. Association between cervicocerebral artery dissection and tortuosity - a review on quantitative and qualitative assessment. Acta Neurochir (Wien) 2024; 166:285. [PMID: 38977512 DOI: 10.1007/s00701-024-06171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
Cervicocerebral artery dissection stands out as a significant contributor to ischemic stroke in young adults. Several studies have shown that arterial tortuosity is associated with dissection. We searched Pubmed and Embase to identify studies on the association between arterial tortuosity and cervicocerebral artery dissection, and to perform a review on the epidemiology of cervicocerebral artery tortuosity and dissection, pathophysiology, measurement of vessels tortuosity, strength of association between tortuosity and dissection, clinical manifestation and management strategies. The prevalence of tortuosity in dissected cervical arteries was reported to be around 22%-65% while it is only around 8%-22% in non-dissected arteries. In tortuous cervical arteries elastin and tunica media degradation, increased wall stiffness, changes in hemodynamics as well as arterial wall inflammation might be associated with dissection. Arterial tortuosity index and vertebrobasilar artery deviation is used to measure the level of vessel tortuosity. Studies have shown an independent association between these two measurements and cervicocerebral artery dissection. Different anatomical variants of tortuosity such as loops, coils and kinks may have a different level of association with cervicocerebral artery dissection. Symptomatic patients with extracranial cervical artery dissection are often treated with anticoagulant or antiplatelet agents, while patients with intracranial arterial dissection were often treated with antiplatelets only due to concerns of developing subarachnoid hemorrhage. Patients with recurrent ischemia, compromised cerebral blood flow or contraindications for antithrombotic agents are usually treated with open surgery or endovascular technique. Those with subarachnoid hemorrhage and intracranial artery dissection are often managed with surgical intervention due to high risk of re-hemorrhage.
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Affiliation(s)
- Mira Salih
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States
| | - Philipp Taussky
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States
| | - Christopher S Ogilvy
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States.
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17
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Bachhuber A. [Imaging in headache]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:425-436. [PMID: 38647549 DOI: 10.1007/s00117-024-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/25/2024]
Abstract
Headache is worldwide one of the leading reasons to consult a general practitioner or a neurologist. In addition to the medical history and results of laboratory parameters, imaging represents one of the most important diagnostic steps. As there is a myriad of possible causes, it is nearly impossible to cover the whole spectrum of this topic. This article summarizes the most important morphological imaging findings and their pitfalls.
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Affiliation(s)
- Armin Bachhuber
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Kirrberger Straße, Gebäude 90, 66421, Homburg/Saar, Deutschland.
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18
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Yaghi S, Engelter S, Del Brutto VJ, Field TS, Jadhav AP, Kicielinski K, Madsen TE, Mistry EA, Salehi Omran S, Pandey A, Raz E. Treatment and Outcomes of Cervical Artery Dissection in Adults: A Scientific Statement From the American Heart Association. Stroke 2024; 55:e91-e106. [PMID: 38299330 DOI: 10.1161/str.0000000000000457] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Cervical artery dissection is an important cause of stroke, particularly in young adults. Data conflict on the diagnostic evaluation and treatment of patients with suspected cervical artery dissection, leading to variability in practice. We aim to provide an overview of cervical artery dissection in the setting of minor or no reported mechanical trigger with a focus on summarizing the available evidence and providing suggestions on the diagnostic evaluation, treatment approaches, and outcomes. Writing group members drafted their sections using a literature search focused on publications between January 1, 1990, and December 31, 2022, and included randomized controlled trials, prospective and retrospective observational studies, meta-analyses, opinion papers, case series, and case reports. The writing group chair and vice chair compiled the manuscript and obtained writing group members' approval. Cervical artery dissection occurs as a result of the interplay among risk factors, minor trauma, anatomic and congenital abnormalities, and genetic predisposition. The diagnosis can be challenging both clinically and radiologically. In patients with acute ischemic stroke attributable to cervical artery dissection, acute treatment strategies such as thrombolysis and mechanical thrombectomy are reasonable in otherwise eligible patients. We suggest that the antithrombotic therapy choice be individualized and continued for at least 3 to 6 months. The risk of recurrent dissection is low, and preventive measures may be considered early after the diagnosis and continued in high-risk patients. Ongoing longitudinal and population-based observational studies are needed to close the present gaps on preferred antithrombotic regimens considering clinical and radiographic prognosticators of cervical artery dissection.
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19
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Griffin KJ, Harmsen WS, Mandrekar J, Brown RD, Keser Z. Epidemiology of Spontaneous Cervical Artery Dissection: Population-Based Study. Stroke 2024; 55:670-677. [PMID: 38288608 DOI: 10.1161/strokeaha.123.043647] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/11/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Cervical artery dissection (CeAD) represents up to 15% to 25% of ischemic strokes in people under the age of 50 years. Noninvasive vessel imaging is increasingly used in clinical practice, but the impact on the frequency of detection of CeAD is unknown. In 2006, the yearly incidence rate of CeAD was estimated at 2.6 per 100 000 person-years, but the current incidence is unknown. METHODS In this population-based retrospective observational cohort study, we utilized the resources of the Rochester Epidemiology Project to ascertain all adult residents of Olmsted County, MN, diagnosed with internal carotid artery dissection and common carotid artery dissection or vertebral artery dissection from 2002 to 2020. Patients with only intracranial involvement or CeAD following major trauma were excluded. Age-adjusted sex-specific and age- and sex-adjusted incidence rates were estimated using the US White 2010 decennial census, with rates expressed per 100 000 person-years. We assessed longitudinal trends by dividing the data into 5-year time intervals, with the last being a 4-year interval. RESULTS We identified 123 patients with a diagnosis of CeAD. There were 63 patients with internal carotid artery dissection, 54 with vertebral artery dissection, 2 with concurrent internal carotid artery dissection and vertebral artery dissection, and 4 with common carotid artery dissection. There were 63 (51.2%) female patients and 60 (48.8%) male patients. The average age at diagnosis was 50.2 years (SD, 15.1 [95% CI, 20.1-90.5] years). The incidence rate of spontaneous CeAD encompassing all locations was 4.69 per 100 000 person-years (2.43 for internal carotid artery dissection and 2.01 for vertebral artery dissection). The incidence rate increased from 2.30 per 100 000 person-years from 2002 to 2006 to 8.93 per 100 000 person-years from 2017 to 2020 (P<0.0001). The incidence rate for female patients rose from 0.81 per 100 000 person-years from 2002 to 2006 to 10.17 per 100 000 person-years from 2017 to 2020. CONCLUSIONS The incidence rate of spontaneous CeAD increased nearly 4-fold over a 19-year period from 2002 to 2020. The incidence rate in women rose over 12-fold. The increase in incidence rates likely reflects the increased use of noninvasive vascular imaging.
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Affiliation(s)
- Kim J Griffin
- Department of Neurology (K.J.G., R.D.B., Z.K.), Mayo Clinic, Rochester, MN
| | - William S Harmsen
- Department of Quantitative Health Sciences (W.S.H., J.M.), Mayo Clinic, Rochester, MN
| | - Jay Mandrekar
- Department of Quantitative Health Sciences (W.S.H., J.M.), Mayo Clinic, Rochester, MN
| | - Robert D Brown
- Department of Neurology (K.J.G., R.D.B., Z.K.), Mayo Clinic, Rochester, MN
| | - Zafer Keser
- Department of Neurology (K.J.G., R.D.B., Z.K.), Mayo Clinic, Rochester, MN
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20
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Long B, Pelletier J, Koyfman A, Bridwell RE. High risk and low prevalence diseases: Spontaneous cervical artery dissection. Am J Emerg Med 2024; 76:55-62. [PMID: 37995524 DOI: 10.1016/j.ajem.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Spontaneous cervical artery dissection (sCAD) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of sCAD, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION sCAD is a condition affecting the carotid or vertebral arteries and occurs as a result of injury and compromise to the arterial wall layers. The dissection most commonly affects the extracranial vessels but may extend intracranially, resulting in subarachnoid hemorrhage. Patients typically present with symptoms due to compression of local structures, and the presentation depends on the vessel affected. The most common symptom is headache and/or neck pain. Signs and symptoms of ischemia may occur, including transient ischemic attack and stroke. There are a variety of risk factors for sCAD, including underlying connective tissue or vascular disorders, and there may be an inciting event involving minimal trauma to the head or neck. Diagnosis includes imaging, most commonly computed tomography angiography of the head and neck. Ultrasound can diagnose sCAD but should not be used to exclude the condition. Treatment includes specialist consultation (neurology and vascular specialist), consideration of thrombolysis in appropriate patients, symptomatic management, and administration of antithrombotic medications. CONCLUSIONS An understanding of sCAD can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
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21
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Rosalik KF, Havemann LM, Wasickanin ME, McCaulley JA, Edwards SM, Leonard KM. Vertebral artery dissection in relation to pregnancy: a case series and literature review. AJOG GLOBAL REPORTS 2023; 3:100281. [PMID: 38046533 PMCID: PMC10692729 DOI: 10.1016/j.xagr.2023.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Cervical artery dissection is an uncommon condition for which pregnancy and postpartum states confer increased risk. Although the majority of patients with this condition fully recover, including resolution of the dissection on imaging, long-term sequelae include a variety of cardiovascular conditions that may be associated with high rates of morbidity and mortality. Here, we review 2 cases of vertebral artery dissection in relation to pregnancy. Our first case will review the management of a pregnant patient with a history of vertebral artery dissection; whereas our second case reviews a presentation of postpartum vertebral artery dissection. Providers should maintain a high suspicion of cervical artery dissection in pregnant and postpartum patients presenting with headache and neck pain.
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Affiliation(s)
- Kendal F. Rosalik
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Drs Rosalik, Wasickanin, McCaulley, and Edwards)
| | - Logan M. Havemann
- Department of Obstetrics and Gynecology, Carl R. Darnall Army Medical Center, Fort Hood, TX (Dr Havemann)
| | - Morgan E. Wasickanin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Drs Rosalik, Wasickanin, McCaulley, and Edwards)
| | - Jill A. McCaulley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Drs Rosalik, Wasickanin, McCaulley, and Edwards)
| | - Sarah M. Edwards
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Drs Rosalik, Wasickanin, McCaulley, and Edwards)
| | - Katherine M. Leonard
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Womack Army Medical Center, Fort Bragg, NC (Dr Leonard)
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Li H, Xu S, Xu B, Zhang Y, Yin J, Yang Y. Unraveling the Links between Chronic Inflammation, Autoimmunity, and Spontaneous Cervicocranial Arterial Dissection. J Clin Med 2023; 12:5132. [PMID: 37568534 PMCID: PMC10419694 DOI: 10.3390/jcm12155132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
Advances in imaging techniques have led to a rise in the diagnosis of spontaneous cervicocranial arterial dissection (SCCAD), which is now considered a common cause of stroke in young adults. However, our understanding of the pathophysiological mechanisms underlying SCCAD remains limited. Prior studies have proposed various factors contributing to arterial wall weakness or stress as potential causes for SCCAD. A combination of biopsies, case reports, and case-control studies suggests that inflammatory changes and autoimmunity may play roles in the cascade of events leading to SCCAD. In this review, we examine the close relationship between SCCAD, chronic inflammation, and autoimmune diseases, aiming to explore potential underlying pathophysiological mechanisms connecting these conditions. While some relevant hypotheses and studies exist, direct evidence on this topic is still relatively scarce. Further investigation of the underlying mechanisms in larger clinical cohorts is needed, and the exploration of animal models may provide novel insights.
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Affiliation(s)
- Hao Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
| | - Shiyao Xu
- The Institute of Neuroscience, Soochow University, Suzhou 215006, China; (S.X.); (Y.Z.)
| | - Beibei Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
| | - Yutong Zhang
- The Institute of Neuroscience, Soochow University, Suzhou 215006, China; (S.X.); (Y.Z.)
| | - Jun Yin
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yi Yang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
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Taylor A, Kerry R, Mourad F, Hutting N. Vascular flow limitations affecting the cervico-cranial region: Understanding ischaemia. Braz J Phys Ther 2023; 27:100493. [PMID: 37027997 PMCID: PMC10102810 DOI: 10.1016/j.bjpt.2023.100493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/15/2022] [Accepted: 02/22/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Blood flow and brain ischaemia have been of interest to physical therapists for decades. Despite much debate, and multiple publications around risk assessment of the cervical spine, more work is required to achieve consensus on this vital, complex topic. In 2020, the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) Cervical Framework adopted the dubious terminology 'vascular pathologies of the neck', which is misleading, on the premise that 1) not all flow limitations leading to ischaemia, are associated with observable blood vessel pathology and 2) not all blood flow limitations leading to ischaemia, are in the anatomical region of the 'neck'. OBJECTIVE This paper draws upon the full body of haemodynamic knowledge and science, to describe the variety of arterial flow limitations affecting the cervico-cranial region. DISCUSSION It is the authors' contention that to apply clinical reasoning and appropriate risk assessment of the cervical spine, there is a requirement for clinicians to have a clear understanding of anatomy/anatomical relations, the haemodynamic science of vascular flow limitation, and related pathologies. This paper describes the wide range of presentations and haemodynamic mechanisms that clinicians may encounter in practice. In cases with a high index suspicion of vascular involvement or an adverse response to assessment/intervention, appropriate referral should be made for further investigations, using consistent terminology. The term 'vascular flow limitation' is proposed when considering the range of mechanisms at play. This fits the terminology used (in vascular literature) at other anatomical sites and is understood by medical colleagues.
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Affiliation(s)
- Alan Taylor
- Faculty of Medicine and Health Sciences, School of Health Sciences, Division of Physical Therapy and Sport Rehabilitation, University of Nottingham, United Kingdom
| | - Roger Kerry
- Faculty of Medicine and Health Sciences, School of Health Sciences, Division of Physical Therapy and Sport Rehabilitation, University of Nottingham, United Kingdom
| | - Firas Mourad
- Department of Physical Therapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg; Luxembourg Health & Sport Sciences Research Institute A.s.b.l., Differdange, Luxembourg
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands.
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Das S, Ray BK, Mishra L, Chatterjee K, Mondal G, Paul DK. The Spectrum of Pediatric Infection-Associated Intracranial Arteriopathies and Acute Ischemic Stroke at 2 Eastern Indian Tertiary Care Centres. J Child Neurol 2023; 38:422-434. [PMID: 37138497 DOI: 10.1177/08830738231171800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Major and minor pediatric infections may cause intracranial arteriopathies, the long-term outcome of which we investigated and identified the factors influencing the progression/resolution of arteriopathies. METHODS We collected the clinical and radiological data of children aged 1 month-15 years who had ischemic stroke with definite arteriopathy following a recent febrile infection. Repeated neuroimaging was done over the next year to ascertain recurrent strokes and the progression and resolution of arteriopathies. RESULTS The anterior circulation was more frequently affected (83.33%), predominantly involving the middle cerebral artery (41.67%), resolving in 20.84% of cases and progressing in 33.33% of cases. Lesions were commonly unilateral (54.17%) and stenotic (75%), resulting predominantly in cortical infarcts (45.83%), with hemiparesis being the most common neurodeficiency. Apart from tubercular meningitis patients, others had a good functional outcome. CONCLUSION Lower age, minor infections, and unilateral arteriopathies had a significantly higher chance of resolution. Postviral arteriopathies had a significantly lower chance of progression compared with those following bacterial infections. Progressive and bilateral arteriopathies were significantly associated with worse outcomes and recurrent strokes.
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Affiliation(s)
- Suman Das
- Department of Neurology, North Bengal Medical College, Shusrutnagar, Darjeeling, West Bengal, India
| | - Biman Kanti Ray
- Department of Neurology, Bangur Institute of Neurology, Kolkata, West Bengal, India
| | | | - Kaushani Chatterjee
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Gobinda Mondal
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Dilip Kumar Paul
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
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25
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Salehi Omran S. Cervical Artery Dissection. Continuum (Minneap Minn) 2023; 29:540-565. [PMID: 37039409 DOI: 10.1212/con.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Cervical artery dissection is a common cause of stroke in young adults. This article reviews the pathophysiology, etiology and risk factors, evaluation, management, and outcomes of spontaneous cervical artery dissection. LATEST DEVELOPMENTS Cervical artery dissection is believed to be a multifactorial disease, with environmental factors serving as possible triggers in patients who have a genetic predisposition to dissection formation. Cervical artery dissection can cause local symptoms or ischemic events, such as ischemic stroke or transient ischemic attack. Neuroimaging is used to confirm the diagnosis; classic findings include a long tapered arterial stenosis or occlusion, dissecting aneurysm, intimal flap, double lumen, or intramural hematoma. Patients with cervical artery dissection who present with an acute ischemic stroke should be evaluated for IV thrombolysis, endovascular therapy eligibility, or both. Antithrombotic therapy with either anticoagulation or antiplatelet treatment is used to prevent stroke from cervical artery dissection. The risk of recurrent ischemia appears low and is mostly limited to the first two weeks after symptom onset. ESSENTIAL POINTS Cervical artery dissection is a known cause of ischemic strokes. Current data show no difference between the benefits and risks of anticoagulation versus antiplatelet therapy in the acute phase of symptomatic extracranial cervical artery dissection, thereby supporting the recommendation that clinicians can prescribe either treatment. Further research is warranted to better understand the pathophysiology and long-term outcomes of cervical artery dissection.
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26
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Latacz P, Lasocha B, Pawel B, Tadeusz P, Marian S. Results of Angioplasty With Double-Layer Mesh Stent and Protection Systems of the Extra- and Intracranial Dissection of Cephalic Arteries. J Endovasc Ther 2023; 30:66-74. [PMID: 35000472 DOI: 10.1177/15266028211068767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Although a majority of cervical artery dissections can be managed conservatively, patients presenting with cerebral embolization or significant stenosis require a more aggressive approach. However, complications associated with endovascular repair are quite frequent and optimal interventional technique still remains to be established. MATERIALS AND METHODS The aim of this post hoc survey was to analyze results of endovascular treatments for symptomatic dissections of the internal carotid and vertebral arteries, which were performed under protection and with the use of double-layer mesh stents. During endovascular procedure catheters, stents and protection systems were tailored according to the angioarchitecture of dissection, particularly to its location, length and coexisting stenotic or aneurysmatic lesions. We evaluated retrospectively midterm and late results of endovascular treatment of 25 patients presenting with symptomatic dissection of cervical arteries, including 11 patients with dissections of intracranial segments of the internal carotid artery. Follow-ups were scheduled 1, 3 and 6 after the procedure, and then every 6 months. Control computed tomography (CT) or digital subtraction angiography (DSA) arteriographies were performed 1-6 months and 12 months after endovascular repair. RESULTS There were no periprocedural major adverse events. All patients completed the 12-month follow-up. There were neither fatalities nor new neurologic adverse events at the 30-day follow-up, and no such adverse events during long-term follow-up. At 12-month follow-up, in all patients, angiographies revealed patent stents, full coverage of lesions by stents and complete thrombotic closure of the pseudoaneurysms. CONCLUSIONS A tailored endovascular management of symptomatic dissection of cervical arteries is safe and efficient, also in a long run.
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Affiliation(s)
- Pawel Latacz
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Bartlomiej Lasocha
- Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Brzegowy Pawel
- Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Popiela Tadeusz
- Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Simka Marian
- Department of Anatomy, University of Opole, Opole, Poland
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Glynn D, Hynes JP, Marnane M, Kavanagh EC. Electric scooter-related triple cervical artery dissection. Radiol Case Rep 2023; 18:1342-1344. [PMID: 36819003 PMCID: PMC9931515 DOI: 10.1016/j.radcr.2022.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023] Open
Abstract
A 34-year-old female presented to the emergency department with neck pain, dysphonia and dysphagia ten days after a fall from an electric scooter. Subsequent computed tomography of the neck revealed bilateral vertebral artery and unilateral internal carotid artery non-occlusive dissections, which were managed with antiplatelet therapy. This case describes mechanisms of injury, clinical presentation, imaging appearances, and subsequent management of cervical artery dissection.
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Affiliation(s)
- David Glynn
- Department of Radiology, National Orthopaedic Hopsital Cappagh, Cappagh Road, Cappoge, Dublin 11, D11 EV29, Ireland,Department of Abdominal Imaging & Intervention, Brigham & Women's Hospital, Boston, MA, USA,Corresponding author.
| | - John P Hynes
- Department of Radiology, National Orthopaedic Hopsital Cappagh, Cappagh Road, Cappoge, Dublin 11, D11 EV29, Ireland
| | - Michael Marnane
- Department of Neurology, Mater Misercordiae University Hospital, Dublin, Ireland
| | - Eoin C Kavanagh
- Department of Radiology, National Orthopaedic Hopsital Cappagh, Cappagh Road, Cappoge, Dublin 11, D11 EV29, Ireland
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Rushton A, Carlesso LC, Flynn T, Hing WA, Rubinstein SM, Vogel S, Kerry R. International Framework for Examination of the Cervical Region for Potential of Vascular Pathologies of the Neck Prior to Musculoskeletal Intervention: International IFOMPT Cervical Framework. J Orthop Sports Phys Ther 2023; 53:7-22. [PMID: 36099171 DOI: 10.2519/jospt.2022.11147] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS: This position statement, stemming from the International IFOMPT (International Federation of Orthopaedic Manipulative Physical Therapists) Cervical Framework, was developed based upon the best contemporary evidence and expert opinion to assist clinicians during their clinical reasoning process when considering presentations involving the head and neck. Developed through rigorous consensus methods, the International IFOMPT Cervical Framework guides assessment of the cervical spine region for potential vascular pathologies of the neck in advance of planned interventions. Within the cervical spine, events and presentations of vascular pathologies of the neck are rare but are an important consideration as part of patient examination. Vascular pathologies may be recognizable if the appropriate questions are asked during the patient history-taking process, if interpretation of elicited data enables recognition of this potential, and if the physical examination can be adapted to explore any potential vasculogenic hypothesis. J Orthop Sports Phys Ther 2023;53(1):7-22. Epub: 14 September 2022. doi:10.2519/jospt.2022.11147.
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Trends in admissions for intracranial dissections in the United States. J Stroke Cerebrovasc Dis 2022; 31:106723. [PMID: 36122494 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Intracranial artery dissection (IAD) is rarer than cervical artery dissections (CeAD), and information is based on limited series with small cohorts. There are only several small-scale studies attempting to characterize the natural history of the disease. Herein, we analyze the prevalence of IADs in hospitalized patients using a national database. METHODS The National Inpatient Sample was queried from 2016-2019 for patients with a diagnosis of unruptured intracranial dissection (uIAD) using ICD-10-CM codes (I67.0). Moreover, patients with acute ischemic stroke (AIS) and CeAD were extracted to compare its prevalence among patients with concomitant AIS (+/-dissections). The Cochrane-Armitage test was conducted to assess trends in the prevalence of uIADs among those with concomitant AIS or among all craniocervical dissections. RESULTS There were 725 hospitalizations involving uIAD, while there were 62,220 involving CeADs. uIADs represented 5.1 per million hospitalizations across 2016-2019. The average age of presentation was 56.9 years (SE: 1.62), while it was 54.4 (SE: 0.17) for CeADs (p = 0.13). Females were represented among 44.8% (n = 325) of uIADs, a similar proportion compared to CeADs (44.3%%, n = 27,530; p = 0.89). Compared to CeADs, AIS and motor deficits were more common in uIAD (71.72% vs. 47.0%; p < 0.001). There were 18.6 uIAD with concomitant AIS per 100,000 with AIS. uIADs represented 1.75% of all dissections with concomitant AIS (n = 520/29,750). There was no trend in the average age of presentation for uIADs. Proportion of females among those with uIADs increased from 36.8% in 2016 to 59.5% in 2019 (trend: +9.46% per year; 95% CI: 3.13 to 15.8; p = 0.004). There was no trend in the proportion of races among those with uIADs. CONCLUSION The prevalence of uIADs among hospitalized patients is very low, and only 1.75% of craniocervical dissection-related AIS is due to uIAD. Compared to CeADs, patients were more likely to be male, and uIAD more commonly led to acute ischemic stroke and motor deficits. The trend in age remained stable across the four years analyzed, while the proportion of females increased. There was no trend in the proportion of races among uIADs, however.
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30
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Sato M, Mizoguchi T, Imamura Y, Yamada Y, Muraya Y, Hashimoto G, Tagawa N, Mori K, Kuwashiro T, Sugimori H, Yasaka M, Okada Y. Usefulness of Ultrasonography in the Diagnosis and Follow-up of Extracranial Vertebral Artery Dissection. Intern Med 2022; 62:1223-1225. [PMID: 36104189 PMCID: PMC10183284 DOI: 10.2169/internalmedicine.0019-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Extracranial vertebral artery dissection is a cerebrovascular disease that occurs most commonly in young people. A 32-year-old man experienced sudden cervical pain and was diagnosed with left vertebral artery dissection after arterial changes were identified by ultrasonography. The reduction in the size of an intramural hematoma in the left vertebral artery and in the peak systolic velocity were evaluated over time. Computed tomography, magnetic resonance imaging, and cerebral angiography are generally performed to diagnose and follow-up extracranial vertebral artery dissection; however, carotid ultrasonography has an advantage over these modalities by enabling the simultaneous observation of vascular morphology and hemodynamics.
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Affiliation(s)
- Marin Sato
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Tadataka Mizoguchi
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Yusuke Imamura
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Yoshitaka Yamada
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Yohei Muraya
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Go Hashimoto
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Naoki Tagawa
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Kota Mori
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Takahiro Kuwashiro
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Hiroshi Sugimori
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
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Keser Z, Chiang CC, Benson JC, Pezzini A, Lanzino G. Cervical Artery Dissections: Etiopathogenesis and Management. Vasc Health Risk Manag 2022; 18:685-700. [PMID: 36082197 PMCID: PMC9447449 DOI: 10.2147/vhrm.s362844] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Cervical Artery Dissection (CeAD) is a frequent stroke etiology for patients younger than 50 years old. The most common immediate complications related to CeAD are headache and neck pain (65-95%), TIA/ischemic stroke (>50%), and partial Horner's syndrome (25%). The prevailing hypothesis regarding the pathogenesis of sCeAD is that the underlying constitutional vessel wall weakness of patients with sCeAD is genetically determined and that environmental factors could act as triggers. The stroke prevention treatment of CeAD remains controversial, involving anticoagulation or antiplatelet therapy and potentially emergent stenting and/or thrombectomy or angioplasty for selected cases of carotid artery dissection with occlusion. The treatment of headache associated with CeAD depends on the headache phenotype and comorbidities. Radiographically, more than 75% of CeAD cases present with occlusion or non-occlusive stenosis. Many patients demonstrate partial and complete healing, more commonly in the carotid arteries. One-fifth of the patients develop dissecting pseudoaneurysm, but this is a benign clinical entity with an extremely low rupture and stroke recurrence risk. Good recovery is achieved in many CeAD cases, and mortality remains low. Family history of CeAD, connective tissue disorders like Ehlers-Danlos syndrome type IV, and fibromuscular dysplasia are risk factors for recurrent CeAD, which can occur in 3-9% of the cases. This review serves as a comprehensive, updated overview of CeAD, emphasizing etiopathogenesis and management.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
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Zhong YL, Feng JP, Luo H, Gong XH, Wei ZH. Spontaneous internal carotid artery pseudoaneurysm complicated with ischemic stroke in a young man: A case report and review of literature. World J Clin Cases 2022; 10:8025-8033. [PMID: 36158486 PMCID: PMC9372827 DOI: 10.12998/wjcc.v10.i22.8025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/04/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carotid artery pseudoaneurysm (PSA) is infrequently encountered in clinical settings. Internal carotid artery (ICA) PSA complicated with ischemic stroke is rare. PSAs are typically caused by iatrogenic injury, trauma, or infection. The underlying mechanisms of spontaneous PSA formation are not well characterized. We report a healthy young man who presented with stroke as a complication of spontaneous PSA of the left ICA.
CASE SUMMARY A 30-year-old man working as a ceiling decoration worker was hospitalized due to sudden-onset speech disorder and right lower extremity weakness. Medical history was unremarkable. Brain computed tomography revealed ischemic stroke. Digital subtraction angiography showed a left ICA PSA with mild stenosis. The patient was conservatively managed with oral anticoagulation and antiplatelet therapy. He recovered well and was discharged. The patient was in good condition during follow-up.
CONCLUSION The occupational history of patient should be taken into consideration while evaluating the etiology of spontaneous ICA PSA in young people with stroke.
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Affiliation(s)
- Yu-Lin Zhong
- Department of Ultrasound, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen 518020, Guangdong Province, China
- Department of Ultrasound, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen 518020, Guangdong Province, China
| | - Jia-Ping Feng
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, Guangdong Province, China
- Graduate School, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China
| | - Hui Luo
- Department of Ultrasound, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen 518020, Guangdong Province, China
- Department of Ultrasound, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen 518020, Guangdong Province, China
| | - Xue-Hao Gong
- Department of Ultrasound, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, Guangdong Province, China
- Graduate School, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China
| | - Zhang-Hong Wei
- Department of Ultrasound, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen 518020, Guangdong Province, China
- Department of Ultrasound, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen 518020, Guangdong Province, China
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Yan Y, Lu Z, Ding Y, Pu J, Hu C, Teng Z, Hui P. Predictors of ischemic events in patients with unilateral extracranial vertebral artery dissection: A single-center exploratory study. Front Neurol 2022; 13:939001. [PMID: 35968293 PMCID: PMC9366300 DOI: 10.3389/fneur.2022.939001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Extracranial vertebral artery dissection (EVAD) is one of the main causes of stroke in young and middle-aged patients. However, the diagnosis is challenging. This study aimed to identify the characteristics of EVAD on color duplex ultrasonography (CDU) and high-resolution magnetic resonance imaging (hrMRI), hoping to improve the accuracy and determine the relative contribution of vessel findings and clinical factors to acute ischemic events. Methods Patients with unilateral EVAD were recruited and divided into ischemia and non-ischemia groups. Clinical features of patients and the lesion location; a variety of signs which indicate dissection, including the presence of an intimal flap, double lumen, intramural hematoma, dissecting aneurysm, intraluminal thrombus, and irregular lumen; and other quantitative parameters of each dissected segment on CDU and hrMRI were reviewed, respectively. Multiple logistic regression was performed to explore the association between clinical, imaging characteristics, and ischemic events in patients with unilateral EVAD. Results Ninety-six patients with unilateral EVAD who met the inclusion criteria were enrolled during a six-year period. Overall, 41 cases (42.7%) were confirmed as ischemic stroke (n = 40) or transient ischemic attack (n = 1) during the 48 h after the onset of symptoms. Men, infections during the last week, and smoking were more common in the ischemia group. Intraluminal thrombus and occlusion on CDU were more prevalent in patients with cerebral ischemia than in those without (36.6 vs. 5.5%; p < 0.001, and 39.0 vs. 9.1%; p = 0.001, respectively). On hrMRI, intraluminal thrombus and occlusion were also more frequent in the ischemia group than in the non-ischemia group (34.1 vs. 5.5%; p < 0.001, and 34.1 vs. 9.1%; p = 0.003, respectively). In addition, lesion length on hrMRI was significantly longer for patients with ischemia (81.5 ± 41.7 vs. 64.7 ± 30.8 mm; p = 0.025). In multivariable logistic regression analysis, male gender, infections during the last week, and the presence of intraluminal thrombus on CDU and hrMRI were independently associated with acute ischemic events. Conclusion Male sex, infections during the last week, and the presence of intraluminal thrombus due to dissection are associated with an increased risk of ischemic events in patients with unilateral EVAD.
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Affiliation(s)
- Yanhong Yan
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziwei Lu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yafang Ding
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhong Pu
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Zhongzhao Teng
| | - Pinjing Hui
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
- Pinjing Hui
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Ranjbar M, Badihian N, Yazdi M, Milani S, Taheri M, Khorvash F, Saadatnia M. "Incidence, characteristics and prognosis of cervical artery dissection-induced ischemic stroke in central Iran". BMC Neurol 2022; 22:227. [PMID: 35729625 PMCID: PMC9210700 DOI: 10.1186/s12883-022-02754-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Ischemic stroke is the most common presentation of cervical artery dissection (CAD). Information regarding CAD-induced stroke is scarce, especially in the Middle East. Here we investigated the incidence of CAD-induced stroke, its characteristics, and the clinical course in central Iran. METHODS This is an observational study conducted in the city of Isfahan, Iran. We recruited patients with ischemic stroke during 2017-2019. We analyzed characteristics of the CAD-induced stroke patients with regards to the involved vessel (internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD)). We assessed functional outcome (modified Rankin Scale [mRS]) and recanalization status after 1 year of follow-up. RESULTS Among 3630 ischemic stroke patients, 51(1.4%) had CAD-induced stroke (mean age: 41.8 ± 12.6; 40.4% female; 28 and 19 ICAD and VAD cases, respectively). The crude incidence rate of CAD-induced stroke was 1.20/100,000/year (0.66/100,000/year and 0.45/100,000/year for strokes due to ICAD and VAD, respectively). mRS ≤ 2 was present in 63.8% of the patients after 1 year of follow-up. History of exercise during the last days before stroke occurrence was associated with a better follow-up mRS (β = -3.1, p-value: 0.037). Administration of anticoagulant or double-antiplatelets was related neither to mRS nor recanalization results. Trauma (27.7%), smoking (21.3%), and headache disorders/migraine (21.3%) were the most common reported factors. CONCLUSION We found a crude incidence rate of 1.20/100,000/year for CAD-induced stroke. Trauma, smoking, and headache disorders were the most common reported factors among our patients. CAD-induced stroke had a favorable long-term prognosis regardless of the type of the involved vessel or the used medication.
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Affiliation(s)
- Mahta Ranjbar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jarib Street, Isfahan, 73461-81746, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negin Badihian
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Yazdi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahaboddin Milani
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Taheri
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jarib Street, Isfahan, 73461-81746, Iran. .,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Saadatnia
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jarib Street, Isfahan, 73461-81746, Iran. .,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Abstract
Cervical artery dissection is a major cause of ischaemic stroke in young adults. The diagnosis can be challenging as some patients may present with seemingly benign symptoms such as a headache, neck pain or dizziness. However, the neurological sequelae of a transient ischaemic attack, vision loss or ischaemic stroke are potentially devastating. All hospital clinicians must be able to recognise this diagnosis and organise timely and appropriate investigations as antithrombotic treatment reduces the risk of stroke recurrence. This article reviews the literature to provide practical information for clinicians to recognise key risk factors and features of history and examination which should raise suspicion of cervical artery dissection. Diagnosis can now be made using the non-invasive, commonly available modalities of computed tomography angiography or magnetic resonance angiography. Timely treatment with antithrombotic agents is recommended to reduce the rate of an ischaemic stroke.
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Affiliation(s)
- Michael Clark
- Department of Stroke Medicine, University Hospital Crosshouse, Kilmarnock, UK
| | - Sudhakar Unnam
- Department of Radiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Sandip Ghosh
- Department of Stroke Medicine, University Hospital Crosshouse, Kilmarnock, UK
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36
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Mayer-Suess L, Geiger M, Dejakum B, Boehme C, Domig LM, Komarek S, Toell T, Kiechl S, Knoflach M. Sex-differences in psychosocial sequelae after spontaneous cervical artery dissection. Sci Rep 2022; 12:611. [PMID: 35022509 PMCID: PMC8755839 DOI: 10.1038/s41598-021-04686-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Short- to mid-term functional outcome in spontaneous cervical artery dissection is favorable, but the concomitant psychosocial impact is underreported. We aimed to determine these possible sequelae, with a special focus on sex differences, in our cohort of spontaneous cervical artery dissection subjects. During a standardized prospective in-house follow-up visit we, among other values, evaluated functional outcome (modified Rankin Scale [mRS]), psychosocial measures (return to work-, divorce rate) and health-related quality of life (WHO-QoL-BREF and SF-36-questionnaires). 145 patients participated in the long-term prospective follow-up. Median follow-up time was 6.5 years and excellent functional outcome (mRS ≤ 1) was achieved in 89.0% subjects. 87.6% returned to work and 17.6% married patients had a divorce during follow-up. Even though relevant baseline-/discharge characteristics and functional outcome did not differ between the sexes, women were less likely to return to work compared to men (79.7% vs. 93.8%; P = 0.010) and divorce rate was considerably higher in women (30.2% vs. 9.2%; P = 0.022). Health related quality of life did not differ significantly between the sexes, but women consistently reported lower values. Even though functional outcome is beneficial in most patients, measures to prevent poor psychosocial outcome should be considered in the long-term care of patients with spontaneous cervical artery dissection, especially women.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Moritz Geiger
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Lena M Domig
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
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37
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Rashed ER, Ruiz Maya T, Black J, Fettig V, Kadian-Dodov D, Olin JW, Mehta L, Gelb BD, Kontorovich AR. Cardiovascular manifestations of hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Vasc Med 2022; 27:283-289. [PMID: 35000503 DOI: 10.1177/1358863x211067566] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Mitral valve prolapse and aortic root dilatation are reported in association with hypermobile Ehlers-Danlos syndrome (hEDS), but the full phenotypic spectrum of cardiovascular complications in this condition has not been studied in the aftermath of updated nosology and diagnostic criteria. Methods: We performed a retrospective review of 258 patients (> 94% adults) referred to a multidisciplinary clinic for evaluation of joint hypermobility between January 2017 and December 2020 and diagnosed with hEDS or a hypermobility spectrum disorder (HSD) to determine the incidence and spectrum of cardiovascular involvement. Results: Mitral valve prolapse was present in 7.5% and thoracic aortic dilatation in 15.2%. Aortic dilatation was more frequent in individuals with hEDS (20.7%) than with HSD (7.7%) and similarly prevalent between males and females, although was mild in > 90% of females and moderate-to-severe in 50% of males. Five individuals (1.9%) with hEDS/HSD had extra-aortic arterial involvement, including cervical artery dissection (CeAD, n = 2), spontaneous coronary artery dissection (SCAD, n = 2), and SCAD plus celiac artery pseudoaneurysm (n = 1). This is the first series to report the prevalence of CeAD and SCAD in hEDS/HSD. Conclusions: Cardiovascular manifestations in adults with hEDS/HSD, especially females, are typically mild and readily assessed by echocardiography. Since the risk of progression has not yet been defined, adults with hEDS/HSD who are found to have aortic dilatation at baseline should continue ongoing surveillance to monitor for progressive dilatation. Cardiovascular medicine specialists, neurologists, and neurosurgeons should consider hEDS/HSD on the differential for patients with CeAD or SCAD who also have joint hypermobility.
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Affiliation(s)
- Eman R Rashed
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tania Ruiz Maya
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Black
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Veronica Fettig
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniella Kadian-Dodov
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey W Olin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lakshmi Mehta
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce D Gelb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy R Kontorovich
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Assif M, Lamy C, De Gaalon S, Caroit Y, Bourcier R, Preterre C, Guillon B. Cervical Artery Dissection in Young Women: Risk of Recurrence During Subsequent Pregnancies. Neurol Clin Pract 2022; 11:e803-e808. [PMID: 34992962 DOI: 10.1212/cpj.0000000000001092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
Objectives To assess the risk of recurrence of cervical artery dissection (CAD) during pregnancy and puerperium in women with a history of CAD and then help physicians with providing medical information to women who wish to become pregnant. Methods Women aged 16-45 years who were admitted to our center for a CAD between 2005 and 2017 were identified from the hospital database, and those with spontaneous and symptomatic CAD were included. They were then contacted to answer a questionnaire that was specifically designed in regard to the recurrence of CAD and pregnancies after the primary CAD. Results Ninety-one patients satisfied our inclusion criteria, and 89 were included in the analysis. During a median follow-up of 7.0 years, 4 women (4.4%) had recurrent CAD, although none during pregnancy or puerperium. Eighteen women (20%) had a total of 20 full-term pregnancies, occurring at least 6 months after CAD. Of these 20 pregnancies, 13 (65%) were vaginal deliveries, and 7 (35%) were cesarean sections. The reason for the absence of pregnancies after the initial CAD was unrelated to the vascular event in 89% of cases, but 8% of the women had been advised by a physician to avoid any future pregnancy or they had been recommended to undergo abortion or sterilization. Conclusion In this study, there were no CAD recurrences during subsequent pregnancies or postpartum, irrespective of the type of delivery. Thus, pregnancy after a history of CAD appears to be safe.
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Affiliation(s)
- Myriam Assif
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Catherine Lamy
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Solène De Gaalon
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Yolande Caroit
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Romain Bourcier
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Cécile Preterre
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Benoit Guillon
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
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39
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Melchenko SA, Golodnev GE, Gumin IS, Tairova RT, Senko IV. [Dissection of brachiocephalic arteries as a complication of open neurosurgery: case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:83-91. [PMID: 35758083 DOI: 10.17116/neiro20228603183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Abnormal styloid processes cause dissection of supra-aortic arteries in some cases. In total, about 33 cases have been described in the world and national literature. However, there were no dissections associated with neurosurgery. At the same time, anomalies of styloid process may be an unidentified cause of many spontaneous dissections of brachiocephalic arteries. OBJECTIVE To analyze modern data on dissection of brachiocephalic arteries associated with anomalies of styloid process and describe dissection in a 44-year-old patient with deviated styloid processes after posterior cranial fossa surgery. MATERIAL AND METHODS Searching for literature data was performed using the keywords "dissection of the cervicocerebral arteries", "dissection of the brachiocephalic arteries", "stylocarotid syndrome" and "Eagle syndrome" in the PubMed and Medscape databases. We also describe a patient hospitalized for microsurgical resection of cystic-solid hemangioblastoma of medulla oblongata who developed postoperative dissection of both internal carotid and vertebral arteries. RESULTS We found 1777 papers between 01/01/1900 and 01/18/2021. In most cases, ICA dissection was not a result of stylocarotid syndrome. There were 121 full-text Russian- or English-language articles. We selected 46 most relevant publications. Analyzing these papers, we found that small distance between the tops of styloid processes and internal carotid arteries can be a risk factor of dissection of brachiocephalic arteries in addition to styloid process elongation. Our patient was diagnosed with just such an anomaly. CONCLUSION Anomalies of styloid processes can cause dangerous vascular complications. Therefore, the length and abnormal deviation of styloid process should be considered when planning intraoperative position of a patient associated with prolonged neck flexion.
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Affiliation(s)
- S A Melchenko
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - G E Golodnev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - I S Gumin
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - R T Tairova
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - I V Senko
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
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40
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Affiliation(s)
- Enrique C Leira
- Department of Neurology, Department of Neurosurgery, Carver College of Medicine and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
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41
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Bodiguel E, Naggara O, Mas JL. Dissecazione delle arterie carotidee e vertebrali extracraniche. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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42
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Debette S, Mazighi M, Bijlenga P, Pezzini A, Koga M, Bersano A, Kõrv J, Haemmerli J, Canavero I, Tekiela P, Miwa K, J Seiffge D, Schilling S, Lal A, Arnold M, Markus HS, Engelter ST, Majersik JJ. ESO guideline for the management of extracranial and intracranial artery dissection. Eur Stroke J 2021; 6:XXXIX-LXXXVIII. [PMID: 34746432 PMCID: PMC8564160 DOI: 10.1177/23969873211046475] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/26/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of the present European Stroke Organisation guideline is to provide clinically useful evidence-based recommendations on the management of extracranial artery dissection (EAD) and intracranial artery dissection (IAD). EAD and IAD represent leading causes of stroke in the young, but are uncommon in the general population, thus making it challenging to conduct clinical trials and large observational studies. The guidelines were prepared following the Standard Operational Procedure for European Stroke Organisation guidelines and according to GRADE methodology. Our four recommendations result from a thorough analysis of the literature comprising two randomized controlled trials (RCTs) comparing anticoagulants to antiplatelets in the acute phase of ischemic stroke and twenty-six comparative observational studies. In EAD patients with acute ischemic stroke, we recommend using intravenous thrombolysis (IVT) with alteplase within 4.5 hours of onset if standard inclusion/exclusion criteria are met, and mechanical thrombectomy in patients with large vessel occlusion of the anterior circulation. We further recommend early endovascular or surgical intervention for IAD patients with subarachnoid hemorrhage (SAH). Based on evidence from two phase 2 RCTs that have shown no difference between the benefits and risks of anticoagulants versus antiplatelets in the acute phase of symptomatic EAD, we strongly recommend that clinicians can prescribe either option. In post-acute EAD patients with residual stenosis or dissecting aneurysms and in symptomatic IAD patients with an intracranial dissecting aneurysm and isolated headache, there is insufficient data to provide a recommendation on the benefits and risks of endovascular/surgical treatment. Finally, nine expert consensus statements, adopted by 8 to 11 of the 11 experts involved, propose guidance for clinicians when the quality of evidence was too low to provide recommendations. Some of these pertain to the management of IAD (use of IVT, endovascular treatment, and antiplatelets versus anticoagulation in IAD with ischemic stroke and use of endovascular or surgical interventions for IAD with headache only). Other expert consensus statements address the use of direct anticoagulants and dual antiplatelet therapy in EAD-related cerebral ischemia, endovascular treatment of the EAD/IAD lesion, and multidisciplinary assessment of the best therapeutic approaches in specific situations.
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Affiliation(s)
- Stephanie Debette
- Bordeaux Population Health research
center, INSERM U1219, University of Bordeaux, Bordeaux, France
- Department of Neurology and
Institute for Neurodegenerative Diseases, Bordeaux University
Hospital, France
| | - Mikael Mazighi
- Department of Neurology, Hopital Lariboisière, Paris, France
- Interventional Neuroradiology
Department, Hôpital Fondation Ophtalmologique
Adolphe de Rothschild, Paris, France
- Université de Paris, Paris, France
- FHU NeuroVasc, Paris, France
- Laboratory of Vascular Translational
Science, INSERM U1148, Paris, France
| | - Philippe Bijlenga
- Neurosurgery, Département de
Neurosciences Cliniques, Hôpitaux Universitaires et Faculté de
Médecine de Genève, Switzerland
| | - Alessandro Pezzini
- Department of Clinical and
Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Masatoshi Koga
- Department of Cerebrovascular
Medicine, National Cerebral and Cardiovascular
Center, Suita, Osaka, Japan
| | - Anna Bersano
- Fondazione IRCCS Istituto Neurologico
'Carlo Besta', Milano
| | - Janika Kõrv
- Department of Neurology and
Neurosurgery, University of Tartu, Tartu, Estonia
- Department of Neurology, Tartu University
Hospital, Tartu, Estonia
| | - Julien Haemmerli
- Neurosurgery, Département de
Neurosciences Cliniques, Hôpitaux Universitaires et Faculté de
Médecine de Genève, Switzerland
| | | | - Piotr Tekiela
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Kaori Miwa
- Department of Cerebrovascular
Medicine, National Cerebral and Cardiovascular
Center, Suita, Osaka, Japan
| | - David J Seiffge
- University Hospital
Bern, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Sabrina Schilling
- Guidelines Methodologist, European Stroke
Organization, Basel, Switzerland
| | - Avtar Lal
- Guidelines Methodologist, European Stroke
Organization, Basel, Switzerland
| | - Marcel Arnold
- University Hospital
Bern, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Hugh S Markus
- Department of Clinical
Neurosciences, University of Cambridge, Cambridge, UK
| | - Stefan T Engelter
- Department of Neurology and
Stroke Center, University Hospital and University of
Basel, Basel, Switzerland
- Neurology and
Neurorehabilitation, University Department of Geriatric
Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
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Engelter ST, Lyrer P, Traenka C. Cervical and intracranial artery dissections. Ther Adv Neurol Disord 2021; 14:17562864211037238. [PMID: 34408787 PMCID: PMC8366117 DOI: 10.1177/17562864211037238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/19/2021] [Indexed: 12/26/2022] Open
Abstract
This review summarizes recent therapeutic advances in cervical (CeAD) and intracranial artery dissection (IAD) research. Despite unproven benefits, but in the absence of any signal of harm, in patients, with acute ischemic stroke attributable to CeAD, intravenous thrombolysis and, in case of large-vessel occlusion, endovascular revascularization should be considered. Future research will clarify which patients benefit most from either treatment modality. For stroke prevention, the recently published randomized controlled TREAT-CAD study showed that, against the initial hypothesis, aspirin was not shown non-inferior to anticoagulation with vitamin K antagonists (VKAs). With the results of two randomized controlled trials (CADISS and TREAT-CAD) available now, the evidence to consider aspirin as the standard therapy of CeAD is weak. Further analyses might clarify whether the assumption supports, in particular, that patients presenting with cerebral ischemia, clinical or subclinical with magnetic resonance imaging surrogates, might benefit most from VKA treatment. In turn, it remains to be shown, whether in CeAD patients presenting with pure local symptoms and without hemodynamic compromise, antiplatelets are sufficient, and whether a dual antiplatelet therapy during the first weeks of treatment is recommendable. The observation that ischemic strokes occurred (or recurred) very early after CeAD diagnosis, consistently across randomized and observational studies, supports the recommendation to start antithrombotic treatment immediately, whatever antithrombotic agent is chosen in each individual case. The lack of a license for the use in CeAD patients and the paucity of data are still arguments against the use of direct oral anticoagulants in CeAD. Nevertheless, due to their beneficial safety and efficacy profile proven in atrial fibrillation, these agents are a worthwhile treatment option to be tested in further CeAD treatment trials. In IAD, the experience with the use of antithrombotic agents is limited. As the risk of suffering intracranial hemorrhage is higher in IAD than in CeAD, the use of antithrombotic therapy in IAD remains controversial.
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Affiliation(s)
- Stefan T Engelter
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Petersgraben 4, Basel 4031, Switzerland
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Schlemm L, von Rennenberg R, Siebert E, Bohner G, Flottmann F, Petzold GC, Thomalla G, Endres M, Nolte CH. Mechanical thrombectomy in patients with cervical artery dissection and stroke in the anterior or posterior circulation - a multicenter analysis from the German Stroke Registry. Neurol Res Pract 2021; 3:20. [PMID: 33934710 PMCID: PMC8091690 DOI: 10.1186/s42466-021-00119-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cervical artery dissection (CAD) is a rare cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO) and may constitute a challenge for mechanical thrombectomy (MT). We compared procedural characteristics, reperfusion rates, and clinical outcome in AIS patients undergoing MT with and without CAD. Methods We performed a pre-specified analysis of patients registered within the German Stroke Registry, a prospectively maintained multicenter registry of consecutive patients with AIS patients treated by MT. Procedural characteristics included time periods and additional application of medication. Results Of 2589 patients, 62 (2.4%) were diagnosed with CAD. CAD patients were younger, had lower rates of known vascular risk factors and larger baseline stroke volumes. MT in CAD patients took significantly longer (median [IQR] groin-puncture-to-flow restoration time: 98 [67–136] versus 70 [45–100] minutes; p < 0.001) and more often required use of intra-arterial medication (34.4% versus 15.6%; p < 0.001). Reperfusion success (modified Treatment in Cerebral Infarction score 2b-3: 85.2% versus 83.3%, p = 0.690) and favorable functional outcome after 3 months (modified Rankin Scale score ≤ 2: 70.9% versus 36.4%, adjusted p = 0.086) did not differ significantly between patients with and without CAD. The latter findings held true for both CAD in the anterior and posterior circulation. Conclusion CAD in AIS requiring MT is rare. MT in patients with CAD constitutes a particular procedural challenge, but still achieves favorable radiological and functional outcomes in most patients. Our data provide indirect evidence that MT is of clinical benefit in patients with AIS due to LVO and CAD. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00119-y.
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Affiliation(s)
- Ludwig Schlemm
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany
| | - Regina von Rennenberg
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,DZNE (German Center for Neurodegenerative Diseases), Partner Site Berlin, Berlin, Germany
| | - Eberhard Siebert
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu, Berlin, Germany
| | - Georg Bohner
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu, Berlin, Germany
| | - Fabian Flottmann
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Martinistr 52, 20246, Hamburg, Germany
| | - Gabor C Petzold
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Bonn, Germany.,Department of Neurology, Division of Vascular Neurology, University Hospital Bonn, Bonn, Germany
| | - Götz Thomalla
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Martinistr. 52, 20246, Hamburg, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,DZNE (German Center for Neurodegenerative Diseases), Partner Site Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany. .,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany. .,DZNE (German Center for Neurodegenerative Diseases), Partner Site Berlin, Berlin, Germany. .,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. .,Department of Neurology, Charite - Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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Vellimana AK, Lavie J, Chatterjee AR. Endovascular Considerations in Traumatic Injury of the Carotid and Vertebral Arteries. Semin Intervent Radiol 2021; 38:53-63. [PMID: 33883802 DOI: 10.1055/s-0041-1724008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cervical carotid and vertebral artery traumatic injuries can have a devastating natural history. This article reviews the epidemiology, mechanisms of injury, clinical presentation, and classification systems pertinent to consideration of endovascular treatment. The growing role of modern endovascular techniques for the treatment of these diseases is presented to equip endovascular surgeons with a framework for critically assessing patients presenting with traumatic cervical cerebrovascular injury.
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Affiliation(s)
- Ananth K Vellimana
- Department of Neurological Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jayson Lavie
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Arindam Rano Chatterjee
- Department of Neurological Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Sun N, Yang XY, Zhao Y, Zhang QJ, Ma X, Wei ZN, Li MQ. Treatment of pediatric intracranial dissecting aneurysm with clipping and angioplasty, and next-generation sequencing analysis: A case report and literature review. World J Clin Cases 2021; 9:1103-1110. [PMID: 33644173 PMCID: PMC7896649 DOI: 10.12998/wjcc.v9.i5.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Large intracranial dissecting aneurysm (IDA) in the anterior cerebral circulation is rare in children. There has been no consensus on the diagnosis and treatment for IDA in children.
CASE SUMMARY We report a 3-year-old boy with a large ruptured IDA in the right middle cerebral artery (16 mm × 14 mm). The IDA was successfully managed with clipping and angioplasty. Next-generation sequencing of the blood sample followed by bioinformatics analysis suggested that the rs78977446 variant of the ADAMTS13 gene is a risk for pediatric IDA. Three years after surgery, the boy was develop-mentally normal.
CONCLUSION Clipping and angioplasty are effective treatments for ruptured IDA in the anterior cerebral circulation. ADAMTS13 rs78977446 is a risk factor for pediatric IDA.
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Affiliation(s)
- Ning Sun
- Department of Neurosurgery, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin 300134, China
| | - Xin-Yu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yan Zhao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qing-Jiang Zhang
- Department of Neurosurgery, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin 300134, China
| | - Xiao Ma
- Department of Neurosurgery, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin 300134, China
| | - Zhong-Nan Wei
- Department of Neurosurgery, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin 300134, China
| | - Meng-Qi Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
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Bonacina S, Locatelli M, Mazzoleni V, Pezzini D, Padovani A, Pezzini A. Spontaneous cervical artery dissection and fibromuscular dysplasia: Epidemiologic and biologic evidence of a mutual relationship. Trends Cardiovasc Med 2021; 32:103-109. [PMID: 33524506 DOI: 10.1016/j.tcm.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
Cervical artery dissection (CeAD) is the most common cause of ischemic stroke in young and middle-aged adults. Over the last decade, a relation between CeAD and fibromuscular dysplasia (FMD), an idiopathic, segmental, non-atherosclerotic and non-inflammatory arterial disease, has been suggested based on a number of epidemiologic observations, while preliminary data support the idea that the two conditions may share common biologic mechanisms. In this article, we review the literature on the relation between CeAD and FMD, focus on the potential pathogenetic mechanisms common to the two conditions, summarize clinical features, management and outcome, and provide support to the hypothesis that the coexistence of the two diseases in one individual might be conceptualized as a distinct non-atherosclerotic non-inflammatory arteriopathy.
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Affiliation(s)
- Sonia Bonacina
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italia
| | - Martina Locatelli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italia
| | - Valentina Mazzoleni
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italia
| | - Debora Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italia
| | - Alessandro Padovani
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italia
| | - Alessandro Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italia.
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Pietzsch JB, Geisler BP, Daniels MJ, Busca RM, Tarantini G, Søndergaard L, Kasner SE. An assessment of annual procedure volumes and therapy adoption of transcatheter closure of patent foramen ovale in four European countries. Eur Stroke J 2020; 6:72-80. [PMID: 33817337 DOI: 10.1177/2396987320939804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/12/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Patent foramen ovale closure reduces recurrence of cryptogenic ischaemic stroke compared to anti-platelet therapy. Our goal was to determine procedure volumes and closure utilisation as a proportion of candidates in four large European countries. Patients and methods National statistics were obtained for Germany, England, France, and Italy for the last available five years (2014-2018). Eligibility was aligned to the enrolment criteria of pivotal trials and current consensus documents. Stroke and transient ischaemic attack incidences were obtained from epidemiological registries and claims data. The eligible candidate pool for analysis included current year candidates plus untreated patients from the prior two years. Absolute strokes avoided assumed the hazard ratio for ischaemic stroke recurrence from a recent meta-analysis. Results In 2018, closure incidence rates were 5.64, 0.53, 2.94 and 5.26 per 100,000 in Germany, England, France and Italy, respectively. This reflects five-year increases of 128% in Germany, 462% in France and 36% in Italy (p < 0.05 for all), and a decline of 37% in England. The proportions of treated patients versus candidates for the combined stroke and transient ischaemic attack pool were 55%, 30%, 80%, and 6%, respectively. Discussion Patent foramen ovale closure volumes increased after the 2017 announcement of positive trial results but still differ substantially across large European countries. If all closure candidates in 2018 with prior ischaemic stroke were treated, the resulting absolute reduction of recurrent ischaemic strokes, compared to anti-platelet therapy alone, would be between 782 and 2295 across the four countries over five years. Conclusion Many eligible patients at risk for a recurrent cryptogenic event might remain untreated due to regional practice variations.
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Affiliation(s)
| | - Benjamin P Geisler
- Wing Tech Inc., Menlo Park, CA, USA.,Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew J Daniels
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Mazzon E, Rocha D, Brunser AM, De la Barra C, Stecher X, Bernstein T, Zúñiga P, Díaz V, Martínez G, Muñoz Venturelli P. Cervical Artery Dissections with and without stroke, risk factors and prognosis: a Chilean prospective cohort. J Stroke Cerebrovasc Dis 2020; 29:104992. [PMID: 32689597 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
We aimed to characterize spontaneous cervical artery dissection (CeAD) patients with and without stroke and describe risk factors for cerebrovascular complications in a Chilean prospective cohort. METHODS Consecutive CeAD patients admitted to a Chilean center confirmed by neuroimaging. Logistic regression was used. RESULTS 168 patients were included, median follow-up time was 157 days. Stroke occurred in 49 (29.2%) cases, 4 (2%) patients died, all of whom had a stroke, and 10 (6%) presented CeAD recurrence. In univariate analyses, men (odds ratio [OR] 3.97, 95% confidence interval [CI] 1.97-8.00, P < 0.001), internal carotid artery CeAD (OR 2.82, 95% CI 1.38-5.78, P = 0.005) and vessel occlusion (OR 4.45, 95% CI 1.38-14.38, P = 0.035) increased stroke risk. Conversely, vertebral artery dissection (OR 0.35, 95% CI 0.16-0.74, P = 0.006) and longer symptom onset to admission (O-A) time (OR 0.79, 95% CI 0.70-0.90, P < 0.001) were associated to decreased stroke risk. After multivariate analysis, men (OR 2.88, 95% CI 1.32-6.27, P = 0.008) and O-A time (OR 0.80, 95% CI 0.69-0.92, P = 0.002) remained independently associated with stroke. CONCLUSION CeAD presented commonly as a non-stroke entity, with favorable prognosis. Albeit to a higher frequency of CeAD in women, stroke occurred predominantly in men, who were admitted earlier.
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Affiliation(s)
- E Mazzon
- Servicio de Neurología, Departmento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - D Rocha
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - A M Brunser
- Servicio de Neurología, Departmento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - C De la Barra
- Departmento de Imagenología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - X Stecher
- Departmento de Imagenología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - T Bernstein
- Departmento de Imagenología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - P Zúñiga
- Departmento de Imagenología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - V Díaz
- Servicio de Neurología, Departmento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - G Martínez
- División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Muñoz Venturelli
- Servicio de Neurología, Departmento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Jia L, Zhang N, Kukun H, Ren L, Zhang L, Lyu J, Liang D, Li Y, Zheng H, Jia W, Liu X. Three-dimensional intra- and extracranial arterial vessel wall joint imaging in patients with cerebrovascular disease. Eur J Radiol 2020; 126:108921. [DOI: 10.1016/j.ejrad.2020.108921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/22/2020] [Accepted: 02/24/2020] [Indexed: 11/16/2022]
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