Early ischemic recurrence in acute spontaneous cervical artery dissection.

Area of Science:

• Neurology
• Vascular Neurology
• Cerebrovascular Diseases

Background:

• Early ischemic recurrence (EIR) after acute spontaneous cervical artery dissection (CeAD) is understudied.
• Understanding EIR prevalence and predictors is crucial for patient management.

Purpose of the Study:

• To determine the prevalence and admission determinants of EIR in a large cohort of CeAD patients.
• To identify imaging markers associated with increased EIR risk.

Main Methods:

• Retrospective analysis of 286 CeAD cases.
• EIR defined as ipsilateral cerebral ischemia or intracranial artery occlusion within 2 weeks post-diagnosis.
• Analysis of CeAD location, stenosis, circle of Willis support, thrombus, and extension using logistic regression.

Main Results:

• EIR occurred in 9% of patients (21/233) within 2 weeks.
• Poor circle of Willis (OR=8.5), intracranial extension beyond V4 (OR=6.8), cervical artery occlusion (OR=9.5), and cervical intraluminal thrombus (OR=17.5) were independently associated with EIR.
• No EIR observed in CeAD without ischemic presentation or <70% stenosis.

Conclusions:

• EIR is more frequent than previously thought following CeAD.
• Admission imaging can stratify EIR risk, identifying patients needing closer monitoring or specific management.
• Poor circle of Willis, intracranial extension, cervical occlusion, and intraluminal thrombus indicate high EIR risk.