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Determinants of neurologic deterioration and stroke-free survival after spontaneous cervicocranial dissections: a
Ameer E Hassan1, Vikram Jadhav, Haralabos Zacharatos
1Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota 55455, USA. ameerehassan@gmail.co
Insights
Spontaneous cervicocranial dissection (SCCD) can lead to neurologic deterioration, especially in women and those with bilateral vertebral or intracranial artery involvement. Early identification of high-risk patients is crucial for better outcomes.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Spontaneous cervicocranial dissection (SCCD) poses a risk of recurrent ischemic events, even with medical therapy.
- Identifying patients prone to neurologic deterioration is vital for treatment planning and risk stratification.
- Limited literature exists on patient selection for interventions like stent placement after SCCD.
Purpose of the Study:
- To determine the rate of neurologic deterioration in medically treated SCCD patients.
- To evaluate demographic, clinical, and radiologic factors associated with neurologic deterioration.
- To identify high-risk patient subgroups for SCCD.
Main Methods:
- Retrospective analysis of 69 SCCD patients from three institutions over seven years.
- Evaluation of demographic, clinical, and angiographical data against neurologic outcomes.
- Kaplan-Meier curves used to assess 1-year event-free survival; logistic regression for risk factors.
Main Results:
- 16% of patients experienced in-hospital neurologic deterioration (TIA, stroke, or death).
- An additional 8 patients had deterioration within one year post-discharge.
- Higher rates of deterioration were observed in women (P=.046), patients with bilateral vertebral artery involvement (P=.02), and intracranial arterial involvement (P=.018).
Conclusions:
- Neurologic deterioration is common in SCCD patients despite medical management.
- Women, patients with bilateral vertebral artery involvement, and those with intracranial arterial involvement are at significantly higher risk.
- These findings highlight the need for targeted monitoring and potential intervention strategies for high-risk SCCD populations.
Abstract:
Patients with spontaneous cervicocranial dissection (SCCD) may experience new or recurrent ischemic events despite antiplatelet or anticoagulant therapy. Treatment with stent placement is an available option; however, the literature on patient selection is limited. Thus, identifying patients at high risk for neurologic deterioration after SCCD is of critical importance. The present study examined the rate of neurologic deterioration in medically treated patients with SCCD and evaluated demographic, clinical, and radiologic factors affecting this deterioration. We retrospectively identified consecutive patients with SCCD over a 7-year period from 3 medical institutions, and evaluated the relationships between demographic data, clinical characteristics, and angiographical findings and subsequent neurologic outcomes. Neurologic deterioration was defined as transient ischemic attack (TIA), ischemic stroke, or death occurring during hospitalization or within 1 year of diagnosis. Kaplan-Meier curves were used to determine neurologic event-free survival up to 12 months. A total of 69 patients (mean age, 47.8 ± 14 years; 45 males) with SCCD were included in the study. Eleven patients (16%) experienced in-hospital neurologic deterioration (TIA in 9, ischemic stroke in 1) or death (1 patient). An additional 8 patients developed neurologic deterioration within 1 year after discharge (TIA in 5, ischemic stroke in 2, and death in 1). The overall 1-year event-free survival rate was 72%. Women (P = .046), patients with involvement of both vertebral arteries (P = .02), and those with intracranial arterial involvement (P = .018) had significantly higher rates of neurologic deterioration. Our findings indicate that neurologic deterioration is relatively common after SCCD despite medical treatment in women, patients with bilateral vertebral artery involvement, and those with intracranial vessel involvement.
