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Early Anticoagulation or Antiplatelet Therapy Is Critical in Craniocervical Artery Dissection: Results from the
Lauren M Rosati1, Alexandra Vezzetti1, Kolby T Redd1
1Department of Neurology, Prisma Health Richland, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
Insights
Craniocervical artery dissection (CeAD) is a leading cause of stroke in young adults. Patients not receiving anticoagulation or antiplatelet therapy had a higher rate of major adverse cardiac events (MACEs).
Area of Science:
- Neurology
- Vascular Medicine
- Cardiology
Background:
- Craniocervical artery dissection (CeAD) is a significant cause of stroke in younger populations.
- Previous studies indicated low rates of major adverse cardiac events (MACEs) in CeAD patients, irrespective of anticoagulation or antiplatelet therapy.
Purpose of the Study:
- To compare the efficacy of anticoagulation versus antiplatelet therapy in managing CeAD patients.
- To analyze the diagnostic characteristics and outcomes of CeAD.
Main Methods:
- A prospective longitudinal registry identified 111 CeAD patients from 2015-2017.
- CeAD was confirmed by imaging and graded using the Denver scale; patients were followed for 12 months for MACE (stroke, TIA, death).
Main Results:
- The study included 111 CeAD patients (mean age 53 years); 82% had extracranial dissections, often linked to trauma or predisposing factors.
- At presentation, 41% had stroke, 5% TIA, 39% headache, and 36% were asymptomatic.
- The 12-month MACE rate was 14%, significantly higher in patients not receiving anticoagulation/antiplatelet therapy (p = 0.008).
Conclusions:
- CeAD diagnosis requires prompt management due to a high early MACE rate.
- Initiating anticoagulation or antiplatelet therapy is crucial for improving outcomes in CeAD patients.
Introduction:
Craniocervical artery dissection (CeAD) is a leading cause of stroke in the young patient population. Recent studies reported a low rate of major adverse cardiac events (MACEs) in patients with CeAD, with no significant difference between patients randomized to anticoagulation or antiplatelet therapy.
Objective:
To compare the effectiveness of anticoagulation and antiplatelet therapy in patients with CeAD.
Methods:
All CeAD patients from 2015 to 2017 were consecutively identified by an electronic medical record-based application and enrolled in this prospective longitudinal registry. CeAD was confirmed by imaging and graded using the Denver scale for blunt cerebrovascular injury. Patients were followed for 12 months for MACE defined as stroke, transient ischemic attack (TIA), or death.
Results:
The cohort included 111 CeAD patients (age 53 ± 15.9 years, 56% Caucasian, 50% female). CeAD was detected by magnetic resonance (5%), computed tomography (88%), or catheter angiography (7%). CeAD was noted in the carotid (59%), vertebral (39%), and basilar (2%) arteries, 82% of which were extracranial dissections. CeAD was classified as grade I, II, III, and IV in 16, 33, 19, and 32%, respectively. A total of 40% of dissections were due to known trauma. A predisposing factor was noted in the majority (78%) of patients, including violent sneezing (21%), carrying a heavy load (19%), sports/recreational activity (11%), chiropractic manipulation (9%), abrupt/prolonged rotation of head (9%), and prolonged phone use (9%). At presentation, 41% had a stroke, 5% had TIA, 39% had headache, and 36% were asymptomatic. Favorable outcome defined as a modified Rankin Scale score of 0-2 was noted in 68% at 3 months and 71% at 12 months. The rate of MACEs at 3 and 12 months was 11 and 14%, respectively, with more events observed in patients who were not receiving anticoagulation/antiplatelet therapy due to contraindications (p = 0.008).
Conclusions:
We report diagnostic characteristics, as well as short- and long-term outcomes of CeAD. A high MACE rate was observed within the first 2 weeks of CeAD diagnosis, notably in patients not initiated on anticoagulation or antiplatelet therapy.
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