Cervical Artery Tortuosity Is Associated With Dissection Occurrence and Late Recurrence: A Nested Case-Control Study

Area of Science:

• Vascular Medicine
• Radiology
• Genetics

Background:

• Spontaneous cervical artery dissection (SCAD) pathogenesis is unclear, with no established recurrence predictors.
• Cervical artery tortuosity, linked to connective tissue disorders, is investigated as a potential SCAD predictor.
• The ReSect study aims to identify risk factors for recurrent cervical artery dissection.

Purpose of the Study:

• To investigate the association between cervical artery tortuosity and spontaneous cervical artery dissection (SCAD).
• To assess if tortuosity predicts SCAD recurrence.
• To explore the link between tortuosity and proteomic markers of SCAD recurrence.

Main Methods:

• Observational study (ReSect) of SCAD patients (1996-2018) with clinical/radiological follow-up.
• Internal carotid and vertebral artery tortuosity assessed via 3D MRI angiography.
• Statistical analyses (χ², Mann-Whitney U, Kruskal-Wallis, logistic regression) compared patients and controls, and recurrence status. Proteomic data analyzed for associations.

Main Results:

• SCAD patients (n=125) showed significantly increased internal carotid artery tortuosity vs. controls (n=24; OR, 2.65).
• Elevated tortuosity was more pronounced in patients with long-term recurrence (n=7; OR, 2.00).
• In SCAD patients (n=37), tortuosity correlated with proteomic markers previously linked to dissection recurrence.

Conclusions:

• Internal carotid artery tortuosity is elevated in SCAD patients, particularly those with recurrence.
• Tortuosity, a measurable biomarker, may suggest subclinical connective tissue disease in SCAD patients.
• The association between tortuosity and proteomic markers enhances its potential as a recurrence biomarker.