Cervical artery dissection in young adults in the stroke in young Fabry patients (sifap1) study
Bettina von Sarnowski1, Ulf Schminke, Ulrike Grittner
1Department of Neurology, University Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
Insights
Cervical artery dissection (CeAD) in young adults has distinct risk factors and clinical features compared to stroke without dissection. Carotid artery dissection (CAD) is more common in women, while vertebral artery dissection (VAD) affects younger patients.
Area of Science:
- Neurology
- Vascular Medicine
- Epidemiology
Background:
- Cervical artery dissection (CeAD) encompasses carotid artery dissection (CAD) and vertebral artery dissection (VAD), often affecting younger individuals with ischemic stroke (IS) or transient ischemic attack (TIA).
- Previous studies suggest differing risk factor profiles and outcomes between CAD and VAD, but large-scale international data comparing CeAD to non-dissection TIA/IS in similar demographics are limited.
Purpose of the Study:
- To compare demographic, clinical, and risk factor profiles of young patients (≤55 years) with CeAD versus those without CeAD.
- To investigate differences in risk factors and clinical features between CAD and VAD subgroups.
Main Methods:
- Analysis of data from the European, multi-center Stroke In young FAbry Patients 1 (sifap1) study.
- Inclusion of 4,208 TIA and IS patients ≤55 years, categorizing 439 (10.4%) with CeAD (CAD, VAD, or multiple/unspecified).
- Subgroup analysis based on age (18-44 vs. 45-55 years), sex, and dissection site.
Main Results:
- CAD prevalence was higher in women (5.9% vs. 3.8%), while VAD prevalence was similar between sexes (4.6% vs. 4.7%).
- VAD patients were younger (median 41 years) than CAD patients (median 45 years).
- Headache was more frequent in CAD and VAD patients compared to non-CeAD stroke. Hypertension, cardiovascular diseases, and patent foramen ovale were less prevalent in CeAD. Smoking, inactivity, obesity, and family history were less common in CAD but not VAD. Migraine history was similar across groups.
Conclusions:
- Young patients with CeAD exhibit distinct clinical features and risk factor profiles compared to non-CeAD TIA/IS patients.
- Specific risk factors differentially influence the likelihood of CAD versus VAD.
- Findings support the concept of distinct etiologies for CAD and VAD.
Background:
Patients with carotid artery dissection (CAD) have been reported to have different vascular risk factor profiles and clinical outcomes to those with vertebral artery dissection (VAD). However, there are limited data from recent, large international studies comparing risk factors and clinical features in patients with cervical artery dissection (CeAD) with other TIA or ischemic stroke (IS) patients of similar age and sex.
Methods:
We analysed demographic, clinical and risk factor profiles in TIA and IS patients ≤55 years of age with and without CeAD in the large European, multi-centre, Stroke In young FAbry Patients 1 (sifap1) study. Patients were further categorised according to age (younger: 18-44 years; middle-aged: 45-55 years), sex, and site of dissection.
Results:
Data on the presence of dissection were available in 4,208 TIA and IS patients of whom 439 (10.4%) had CeAD: 196 (50.1%) had CAD, 195 (49.9%) had VAD, and 48 had multiple artery dissections or no information regarding the dissected artery. The prevalence of CAD was higher in women than in men (5.9 vs. 3.8%, p < 0.01), whereas the prevalence of VAD was similar in women and men (4.6 vs. 4.7%, n.s.). Patients with VAD were younger than patients with CAD (median = 41 years (IQR = 35-47 years) versus median = 45 years (IQR = 39-49 years); p < 0.01). At stroke onset, about twice as many patients with either CAD (54.0 vs. 23.1%, p < 0.001) or VAD (63.4 vs. 36.6%, p < 0.001) had headache than patients without CeAD and stroke in the anterior or posterior circulation, respectively. Compared to patients without CeAD, hypertension, concomitant cardiovascular diseases and a patent foramen ovale were significantly less prevalent in both CAD and VAD patients, whereas tobacco smoking, physical inactivity, obesity and a family history of cerebrovascular diseases were found less frequently in CAD patients, but not in VAD patients. A history of migraine was observed at a similar frequency in patients with CAD (31%), VAD (27.8%) and in those without CeAD (25.8%).
Conclusions:
We identified clinical features and risk factor profiles that are specific to young patients with CeAD, and to subgroups with either CAD or VAD compared to patients without CeAD. Therefore, our data support the concept that certain vascular risk factors differentially affect the risk of CAD and VAD.
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