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Atherosclerosis in patients with cervical artery dissection
Eveline Brunner1,2, Josefin E Kaufmann1,2, Sandro Fischer1,2
1Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Insights
Cervical artery dissection (CeAD) co-occurrence with atherosclerosis was studied. Atherosclerosis was found in 12% at baseline and 11% developed it over 5 years, potentially lowering CeAD recurrence risk.
Area of Science:
- Vascular Medicine
- Neurology
- Cardiology
Background:
- Cervical artery dissection (CeAD) is typically non-atherosclerotic, but co-existing atherosclerosis is possible.
- This study investigated the frequency and clinical significance of atherosclerosis in CeAD patients.
Purpose of the Study:
- To determine the prevalence of atherosclerosis in patients with CeAD.
- To assess the association between co-existing atherosclerosis and CeAD recurrence.
- To evaluate the link between atherosclerosis and subsequent vascular events in CeAD patients.
Main Methods:
- A single-center study reviewed duplex ultrasound images of 294 CeAD patients.
- Atherosclerosis was assessed for carotid intima-media thickness, plaques, and stenosis at baseline and follow-up.
- Logistic regression analyzed differences in CeAD recurrence and vascular events between patients with and without atherosclerosis.
Main Results:
- At baseline, 12% of CeAD patients showed atherosclerotic signs; an additional 11% developed them over a median 55.7-month follow-up.
- Patients with atherosclerosis had significantly lower odds of CeAD recurrence (OR 0.03).
- Vascular event rates were similar between groups (15% with atherosclerosis vs. 8.5% without), though not statistically significant.
Conclusions:
- Carotid atherosclerosis is detectable in a notable proportion of CeAD patients, both at presentation and developing over time.
- The presence of atherosclerosis may be associated with a reduced risk of CeAD recurrence.
- Further research is needed to clarify if atherosclerosis increases the risk of late-stage vascular events in CeAD patients.
Introduction:
Cervical artery dissection (CeAD) is considered a non-atherosclerotic arteriopathy, but atherosclerosis of the cervical arteries may co-exist. We explored the frequency and clinical importance of co-existent atherosclerosis in patients with CeAD.
Patients And Methods:
Single-center exploratory study from the Stroke Center Basel, Switzerland. We re-reviewed duplex ultrasound images at (i) baseline and (ii) last follow-up visit for the presence versus absence of the following atherosclerotic manifestations in the carotid arteries: (i) abnormal carotid intima-media thickness, (ii) plaques, and (iii) atherosclerotic stenosis. We investigated whether CeAD patients with versus without co-existing atherosclerosis differ regarding (a) recurrence of CeAD and (b) occurrence of vascular events (myocardial infarction, peripheral artery disease, or ischemic stroke) using logistic regression with adjustment for age and follow-up time.
Results:
Among 294 CeAD patients (median age 46 [IQR 37-53], 41.8% women), 35 (12%) had any atherosclerotic signs at baseline. Among 196 patients with available follow-up, another 21/196 (11%) patients developed atherosclerosis during a median follow-up of 55.7 months. Patients with atherosclerosis had decreased odds of recurrent CeADs when compared to patients without atherosclerosis (OR 0.03, 95% CI = 0.00-0.30). During follow-up, 6 (15%) vascular events occurred among 40 CeAD patients with atherosclerosis and 13 (8.5%) among 153 patients without atherosclerosis (OR 1.38, 95% CI = 0.39-4.55, data for 3 patients were missing).
Discussion And Conclusion:
Signs of atherosclerosis in the carotid artery were detectable in 12% of CeAD patient at baseline. Additionally, 11% of CeAD patients developed new signs of atherosclerosis within the following 5 years. The presence of atherosclerosis may suggest a lower risk for recurrent CeAD. Whether it might indicate an increased risk for late clinical vascular events deserves further studies.
