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Adult cervicocerebral artery dissection: a single-center study of 301 Finnish patients
T M Metso1, A J Metso, O Salonen
1Department of Neurology Helsinki University Central Hospital, Helsinki, Finland.
Insights
Spontaneous cervicocerebral artery dissection (CAD) is more common in men and associated with smoking and migraine. Artery occlusion, internal carotid artery dissection (ICAD), and infection predict poorer outcomes in CAD patients.
Area of Science:
- Neurology
- Vascular Medicine
- Epidemiology
Background:
- Limited research exists on risk factors and prognosis for adult spontaneous cervicocerebral artery dissection (CAD).
- Understanding these factors is crucial for patient management and outcomes.
Purpose of the Study:
- To investigate prognostic factors and associations of CAD with vascular risk factors.
- To analyze outcomes in a large cohort of Finnish patients.
Main Methods:
- Retrospective, hospital-based analysis of 301 consecutive Finnish patients diagnosed with CAD between 1994 and 2007.
- Evaluation of demographic data, vascular risk factors, and clinical outcomes.
Main Results:
- CAD predominantly affected men (68%); women were younger.
- Migraine with visual aura (36%) and smoking were more prevalent in CAD patients.
- Favorable outcomes were achieved by 83% at 3 months. Artery occlusion, internal carotid artery dissection (ICAD), and infection correlated with poorer outcomes.
- Stroke severity was higher in ICAD patients, despite less frequent infarction. Mortality was 2.3%, and recurrence was 2%.
Conclusions:
- Male sex, smoking, and migraine are associated with CAD.
- Artery occlusion, ICAD, and infection are linked to adverse outcomes in CAD patients.
Background And Purpose:
There are only few small studies assessing potential risk factors, comorbidity, and prognostic factors in adult spontaneous cervicocerebral artery dissection (CAD).
Methods:
We conducted a retrospective, hospital-based analysis on the prognostic factors and association of CAD with vascular risk factors in 301 consecutive Finnish patients, diagnosed from 1994 to 2007.
Results:
Two thirds of the patients were men (68%). Women were younger than men. Migraine (36% of all patients), especially with visual aura (63% of all migraineurs), and smoking were more common in patients with CAD compared with the general Finnish population. At 3 months, 247 (83%) patients reached a favorable outcome. Occlusion of the dissected artery, internal carotid artery dissection (ICAD), and recent infection in infarction patients were associated with a poorer outcome. ICAD patients had less often brain infarction, but the strokes they had were more severe. Seven (2.3%) patients died during the follow-up (mean 4.0 years, 1186 patient years). Six (2%) patients had verified CAD recurrence.
Conclusions:
This study provides evidence for the association of CAD with male sex, and possible association with smoking and migraine. Occlusion of the dissected artery, ICAD, and infection appear to be associated with poorer outcome.
