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Published on: April 15, 2021
Clinical and radiographic natural history of cervical artery dissections
Neil E Schwartz1, A Talia Vertinsky, Karen G Hirsch
1Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California 94304, USA. neuro1@stanford.edu
Insights
Cervical artery dissection (CAD) in young patients has a low recurrence rate, with most cases showing vessel recanalization. Treatment choice did not impact recurrent ischemic events.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Cervical artery dissection (CAD) is a significant cause of stroke in young individuals.
- Limited long-term data exists on clinical and radiographic outcomes in large CAD populations.
Purpose of the Study:
- To analyze long-term outcomes and features of cervical artery dissection (CAD).
- To evaluate recurrence rates and recanalization in a large patient cohort.
Main Methods:
- Retrospective analysis of 177 patients with confirmed CAD over 15 years.
- Extraction of epidemiologic data, treatment, recurrence, and vessel status.
- Detailed imaging analysis in a subset of 51 cases.
Main Results:
- 177 patients identified (mean age 44.0 years); 60% spontaneous dissections.
- Recurrent ischemic events occurred in 8.5% of patients; 1.1% recurrent dissection.
- Recanalization observed in 58.8% of cases, more frequent in women; complete occlusions showed less recanalization.
Conclusions:
- Cervical artery dissection (CAD) generally follows a benign clinical course.
- Low recurrence rates are supported, irrespective of antithrombotic therapy type or duration.
Background:
Cervical artery dissection (CADsx) is a common cause of stroke in young patients, but long-term clinical and radiographic follow-up from a large population is lacking.
Methods:
Epidemiologic data, treatment, recurrence, and other features were extracted from the records of all patients seen at our stroke center with confirmed CAD during a 15-year period. A subset of cases was examined to provide detailed information about vessel status.
Results:
In all, 177 patients (mean age 44.0 +/- 11.1 years) were identified, with the male patients being older than the female patients. Almost 60% of dissections were spontaneous, whereas the remainder involved some degree of head and/or neck trauma. More than 70% of patients were treated with anticoagulation. During follow-up (mean 18.2 months; 0-220 months) there were 15 cases (8.5%) of recurrent ischemic events, and two cases (1.1%) of a recurrent dissection. About half of recurrent stroke/transient ischemic attack events occurred within 2 weeks of presentation. There was no clear association between the choice of antithrombotic agent and recurrent ischemic events. Detailed analysis of imaging findings was performed in 51 cases. Some degree of recanalization was seen in 58.8% of patients overall, and was more frequent in women. The average time to total or near-total recanalization was 4.7 +/- 2.5 months. Patients with complete occlusions at presentation tended not to recanalize.
Conclusions:
This large series from a single institution highlights many of the features of CAD. A relatively benign course with low recurrence rate is supported, independent of the type and duration of antithrombotic therapy.
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