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Recurrent versus first cervical artery dissection - a retrospective study of clinical and vascular characteristics
M Kloss1, L Kalashnikova2, L Dobrynina2
1Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Insights
Recurrent cervical artery dissection (CeAD) is less likely to cause ischemic events than initial dissections. Patients with non-ischemic initial CeAD have a very low risk of ischemic symptoms upon recurrence.
Area of Science:
- Neurology
- Vascular Medicine
- Stroke Research
Background:
- Recurrent cervical artery dissection (CeAD) events often occur soon after the initial event.
- Understanding the characteristics of recurrent CeAD is crucial for patient management and risk stratification.
Purpose of the Study:
- To compare the clinical and vascular characteristics of recurrent CeAD events with first-time CeAD events.
- To identify associations between subsequent CeAD events within individual patients.
Main Methods:
- Retrospective selection of 76 patients with new CeAD events during 3-6 month follow-up from seven stroke centers.
- Comparison of clinical and vascular features of initial and recurrent CeAD events.
Main Results:
- Recurrent CeADs were less frequently occlusive or ischemic compared to first CeADs.
- A significant proportion of recurrent dissections affected bilateral arteries (internal carotid or vertebral).
- Patients with non-ischemic first CeAD had a very low risk (1.3%) of experiencing ischemic symptoms with recurrent CeAD.
Conclusions:
- Recurrent CeAD typically involves the same arterial site and is less likely to cause ischemic events than the first CeAD.
- The risk of ischemic symptoms in recurrent CeAD is minimal for patients whose initial dissection was non-ischemic.
Background And Purpose:
Most recurrent cervical artery dissection (CeAD) events occur shortly after the acute first CeAD. This study compared the characteristics of recurrent and first CeAD events and searched for associations between subsequent events of an individual person.
Methods:
Cervical artery dissection patients with a new CeAD event occurring during a 3-6 month follow-up were retrospectively selected in seven specialized stroke centers. Clinical and vascular characteristics of the initial and the recurrent CeADs were compared.
Results:
The study sample included 76 patients. Recurrent CeADs were occlusive in one (1.3%) patient, caused cerebral ischaemia in 13 (17.1%) and were asymptomatic in 39 (51.3%) patients, compared to 29 (38.2%) occlusive, 42 (55.3%) ischaemic and no asymptomatic first CeAD events. In 52 (68.4%) patients, recurrent dissections affected both internal carotid arteries or both vertebral arteries, whilst 24 (31.6%) patients had subsequent dissections in both types of artery. Twelve (28.6%) of 42 patients with an ischaemic first dissection had ischaemic symptoms due to the recurrent CeADs, too. However, only one (1.3%) of 34 patients with a non-ischaemic first CeAD suffered ischaemia upon recurrence.
Conclusion:
Recurrent CeAD typically affects the same site of artery. It causes ischaemic events less often than the first CeAD. The risk that patients who presented with solely non-ischaemic symptoms of a first CeAD will have ischaemic symptoms in the case of a recurrent CeAD seems very small.
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