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Stenting as a treatment for cranio-cervical artery dissection: Improved major adverse cardiovascular event-free
Alexandra Vezzetti1, Lauren M Rosati1, Forrest J Lowe1
1Department of Neurology, Radiology and Neurosurgery, Prisma Health Richland, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
Insights
Stenting may benefit patients with cranio-cervical artery dissection (CeAD), reducing major adverse cardiovascular events (MACE). Further randomized trials are needed to confirm these findings for CeAD treatment.
Area of Science:
- Neurology
- Vascular Surgery
- Cardiology
Background:
- Cranio-cervical artery dissection (CeAD) is a significant cause of cerebrovascular events, particularly in younger individuals.
- Current treatment strategies for CeAD lack established guidelines, necessitating further research into effective interventions.
Purpose of the Study:
- To evaluate the incidence of major adverse cardiovascular events (MACE) in patients with CeAD.
- To compare outcomes between CeAD patients treated with stent placement versus medical management alone.
Main Methods:
- The study utilized the COMParative effectiveness of treatment options in cervical Artery diSSection (COMPASS) registry, a retrospective, longitudinal cohort.
- 110 adult patients with confirmed cranio-cervical artery dissection were followed for one year to assess MACE.
Main Results:
- Ten patients (10%) underwent stent placement for high-grade stenosis or pseudoaneurysm, experiencing no MACE during follow-up.
- CeAD patients treated solely with medical management had a 14% incidence of MACE at one year.
- No procedural or in-hospital complications were observed in the stented group.
Conclusions:
- Stent placement in CeAD patients appears beneficial, especially in cases of high-grade stenosis or expanding pseudoaneurysm.
- These findings suggest stenting as a potentially effective treatment option for specific CeAD presentations.
- Confirmation through a randomized clinical trial is recommended to validate these observational results.
Introduction:
Cranio-cervical artery dissection (CeAD) is a common cause of cerebrovascular events in young subjects with no clear treatment strategy established. We evaluated the incidence of major adverse cardiovascular events (MACE) in CeAD patients treated with and without stent placement.
Methods:
COMParative effectiveness of treatment options in cervical Artery diSSection (COMPASS) is a single high-volume center observational, retrospective longitudinal registry that enrolled consecutive CeAD patients over a 2-year period. Patients were ≥ 18 years of age with confirmed extra- or intracranial CeAD on imaging. Enrolled participants were followed for 1 year evaluating MACE as the primary endpoint.
Results:
One-hundred ten patients were enrolled (age 53 ± 15.9, 56% Caucasian, and 50% male, BMI 28.9 ± 9.2). Grade I, II, III, and IV blunt vascular injury was noted in 16%, 33%, 19%, and 32%, respectively. Predisposing factors were noted in the majority (78%), including sneezing, carrying heavy load, chiropractic manipulation. Stent was placed in 10 (10%) subjects (extracranial carotid n = 9; intracranial carotid n = 1; extracranial vertebral n = 1) at the physician's discretion along with medical management. Reasons for stent placement were early development of high-grade stenosis or expanding pseudoaneurysm. Stented patients experienced no procedural or in-hospital complications and no MACE between discharge and 1 year follow up. CeAD patients treated with medical management only had 14% MACE at 1 year.
Conclusion:
In this single high-volume center cohort of CeAD patients, stenting was found to be beneficial, particularly with development of high-grade stenosis or expanding pseudoaneurysm. These results warrant confirmation by a randomized clinical trial.
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