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Differential outcomes and treatment in non-traumatic carotid versus vertebral cervical artery dissection: A national
Elizabeth Lee1, Liqi Shu1, Setareh Salehi Omran2
1Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States.
Insights
This study reveals significant differences in patient characteristics and outcomes between carotid artery dissection and vertebral artery dissection. Carotid dissection is linked to higher mortality, emphasizing the need for tailored treatments.
Area of Science:
- Neurology
- Vascular Medicine
- Epidemiology
Background:
- Cervical artery dissection (CAD) affects the carotid or vertebral arteries, but comparative studies on their clinical features and outcomes are limited.
- Understanding these differences is crucial for effective patient management and treatment strategies.
Purpose of the Study:
- To compare the clinical features, comorbidities, treatment patterns, and in-hospital outcomes of non-traumatic carotid artery dissection (CAD) versus vertebral artery dissection (VAD).
- To identify distinct characteristics that may inform tailored therapeutic approaches for each type of cervical artery dissection.
Main Methods:
- Retrospective analysis of 123,224 non-traumatic CAD admissions from the National Inpatient Sample (2005-2019), excluding cases with concurrent carotid and vertebral dissections.
- Patient demographics, comorbidities, and treatments were evaluated.
- Survey-weighted logistic regression and adjusted multivariable regressions were used to assess differences in in-hospital mortality and routine discharge rates.
Main Results:
- Carotid dissection (67,533 cases) was more common than vertebral dissection (55,691 cases).
- Carotid dissection was associated with older age, Black and White race, atrial fibrillation, aortic dissection, and fewer concurrent acute ischemic strokes (AIS).
- Patients with carotid dissection and AIS showed higher NIHSS scores and increased utilization of thrombolysis, endovascular therapy, and angioplasty. Carotid dissection correlated with higher in-hospital mortality and lower rates of routine discharge.
Conclusions:
- Significant disparities exist in comorbidity profiles and treatment strategies between non-traumatic carotid and vertebral artery dissections.
- Findings support the development of individualized treatment plans based on the specific type of cervical artery dissection to improve patient outcomes.
Introduction:
Cervical artery dissection (CAD) involves the carotid or vertebral artery. However, limited studies have compared their clinical features and outcomes.
Methods:
We examined non-traumatic CAD patients from the National Inpatient Sample (2005-2019). Those diagnosed with both carotid and vertebral artery dissections were excluded. The evaluation included patient demographics, comorbidities, and treatment. Differences between carotid and vertebral dissections were assessed using survey-weighted stepwise backward logistic regression, followed by adjusted multivariable regressions for the primary outcomes of in-hospital mortality and routine discharge (to home or self-care).
Results:
From 2005 to 2019, we included 123,224 non-traumatic CAD admissions without concurrent vertebral and carotid dissections. There were more carotid dissections than vertebral dissections (67,533 vs. 55,691). Compared to vertebral dissection, carotid dissection was associated with older age (54 [44-66] years vs. 49 [37-62] years, P<0.001), Black race (12.6% vs. 8.8%, P<0.001), White race (73.5% vs. 72.0%, P = 0.024), atrial fibrillation (10.8% vs. 6.3%, P<0.001), aortic dissection (7.7% vs. 0.3%, P<0.001), and fewer concurrent acute ischemic strokes (AIS) (47.8% vs. 56.7%, P<0.001).Within the concurrent AIS group, carotid CAD patients exhibited higher NIHSS (8 [2-17] vs. 2 [0-5], P<0.001), an increased utilization of intravenous thrombolysis (6.7% vs. 2.7% P<0.001), endovascular therapy (13.3% vs. 3.3%, P<0.001), and angioplasties (9.8% vs. 0.3%, P<0.001). Overall, carotid CAD was associated with more inpatient deaths (aOR 1.30, 95% CI 1.04-1.62, P=0.023) and less routine discharges (aOR 0.88, 95% CI 0.79-0.97, P=0.014) than vertebral CAD.
Conclusion:
Our study underscores distinct comorbidity profiles and treatment patterns between non-traumatic carotid dissection and vertebral dissection groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.
