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Recanalization and Functional Outcome in Patients with Cervico-cephalic Arterial Dissections
Ankur Wadhwa1, Mohammed Almekhlafi2, Bijoy K Menon3
1Department of Medicine, Section of Neurology, University of Manitoba, Winnipeg, Canada.
Insights
Cervico-cephalic arterial dissections (CeAD) show good recanalization rates and functional outcomes in young stroke patients. Hypertension may impact recanalization, but outcomes are not significantly influenced by recanalization status.
Area of Science:
- Neurology
- Vascular Medicine
- Stroke Research
Background:
- Cervico-cephalic arterial dissections (CeAD) are a significant cause of stroke in young individuals.
- Understanding recanalization and its impact on outcomes is crucial for managing CeAD.
Purpose of the Study:
- To determine the frequency and predictors of recanalization in spontaneous CeAD.
- To investigate the effect of recanalization on functional outcomes in patients with CeAD.
Main Methods:
- Patients with acute ischemic stroke secondary to CeAD were identified using CT angiography (CTA).
- Treatment strategies included single, dual, or triple antiplatelet therapy.
- Follow-up imaging and Modified Rankin Scale (mRS) assessments were used to evaluate outcomes.
Main Results:
- Complete recanalization was observed in 27 out of 34 patients (79.4%).
- Hypertension was noted in all non-recanalized patients.
- A good clinical outcome (mRS ≤ 2) was achieved by 47 patients, irrespective of recanalization status.
Conclusions:
- CeAD demonstrates favorable recanalization rates and neurological outcomes, even with initial complete vessel occlusion.
- Hypertension may be a factor influencing recanalization.
- Further trials are needed to assess the efficacy of dual antiplatelets and heparin for early recanalization.
Background:
Cervico-cephalic arterial dissections (CeAD) are an important cause of stroke in young patients. This study aimed to determine the frequency and predictors of recanalization in spontaneous CeAD and to study the effect of recanalization on functional outcomes.
Methods:
We identified patients presenting with acute ischemic stroke secondary to CeAD from the CT angiography (CTA) database of the Calgary Stroke Program. Dissections were diagnosed based on standard clinical and imaging findings. At the discretion of treating stroke Neurologists, the patients were either treated with single antiplatelet or dual antiplatelet or triple therapy. Follow-up imaging with CTA, magnetic resonance imaging, and DSA was completed, and a Modified Rankin scale (mRS) was performed to determine the outcome.
Results:
Fifty-six patients with CeAdD were studied. Thirty-four patients (18 VAD; vertebral artery dissection and 16 CAD; carotid artery dissection) were followed up for recanalization. Complete recanalization was observed in 27 subjects; 13 patients with VAD recanalized in comparison to 14 with CAD (p = 0.40). All non-recanalized patients had hypertension. A good clinical outcome (mRS ≤ 2) was observed in 47 patients. Interestingly, the likelihood of a good neurological outcome was not influenced by recanalization status. There was no difference in clinical outcome for different sites in VAD, whereas patients with intracranial CAD had severe strokes (NIHSS > 21).
Conclusions:
CeAD has good recanalization rates and neurological outcomes, with recanalization seen even in vessels with initial complete occlusion. The presence of hypertension may influence recanalization. The efficacy of dual antiplatelets and heparin for early recanalization needs to be assessed in future clinical trials.
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