Risk Prediction of Cerebrovascular Ischemic Events Following Cervical Artery Dissections Using High-Intensity
Seyed Behnam Jazayeri1, Behnam Sabayan2,3, Yasaman Pirahanchi4
1Tehran University of Medical Sciences, Tehran, Iran.
Insights
High-intensity transient signals (HITS) detected by Transcranial Doppler (TCD) predict recurrent ischemic events in carotid artery dissections. This finding aids in identifying high-risk patients for proactive management.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Spontaneous Cervical Artery Dissections (CeAD) pose management challenges due to difficulties in identifying high-risk individuals.
- Early prediction of recurrent ischemic events (IEs) following CeAD is crucial for timely intervention.
Purpose of the Study:
- To evaluate the predictive value of high-intensity transient signals (HITS) detected by Transcranial Doppler (TCD) for recurrent ischemic events (IEs) in patients with CeAD.
- To synthesize evidence from existing literature and a new cohort study.
Main Methods:
- A systematic review and meta-analysis of studies on HITS in CeAD patients predicting IEs, adhering to PRISMA guidelines.
- Data from five prior studies and a retrospective cohort of 34 CeAD patients were pooled.
- Subgroup analysis examined the influence of dissected artery type (carotid vs. vertebral) on HITS predictive value.
Main Results:
- Meta-analysis revealed HITS as a significant predictor of IEs (OR: 13.25, 95% CI [2.97-59.13]), with low heterogeneity (I2=42%).
- HITS significantly predicted IEs in carotid artery dissections (p<0.01) but not vertebral artery dissections (p=0.11).
- In the cohort, 20% experienced IEs, all with HITS; multivariable analysis identified HITS (p=0.006) and intra-luminal thrombosis (p=0.02) as significant predictors.
Conclusions:
- HITS detected by TCD are a strong predictor of IEs in patients with carotid artery dissections.
- TCD's clinical utility in identifying high-risk CeAD patients is highlighted.
- Findings support the need for proactive management strategies in this subgroup to reduce future ischemic events.
Background:
Predicting and managing spontaneous Cervical Artery Dissections (CeAD) is challenging due to the absence of tools for early identification of high-risk individuals. This study seeks to gather evidence on the predictive value of high-intensity transient signals (HITS) detected by Transcranial Doppler for recurrent ischemic events (IEs) following CeAD.
Methods:
We performed a systematic review and meta-analysis of published studies along with the data from our cohort. Following PRISMA guidelines, we searched Pubmed, Embase and Scopus to identify studies that evaluated HITS in patients with CeAD with the aim of predicting IEs. Data were pooled using a random effects model, with odds ratio (OR) and its 95% confidence interval (CI) as the effect size. Heterogeneity was assessed with the Q statistic and I2 test, while subgroup analysis evaluated the impact of dissected artery (carotid vs vertebral) on the relationship between HITS and ischemic events. Our retrospective study included consecutive patients diagnosed with CeAD, followed for 90 days to record IEs. Univariable and multivariable analyses were performed to identify factors associated with recurrent TIAs or strokes within 90 days post-CeAD.
Results:
Our systematic review included five prior studies, which, combined with our center's sample size, provided data for a total of 306 patients. The meta-analysis indicated that HITS is a significant predictor of IEs (OR: 13.25, 95% CI [2.97-59.13], p<0.01) with low heterogeneity (I2 = 42%, p = 0.13). However, subgroup analysis indicated that HITS are a significant predictor only for carotid artery dissections (p<0.01), and not for vertebral artery dissections (p=0.11). The cohort consisted of 34 patients (mean age: 46.8 years, 55.9% male). The incidence of IEs was 20% in our cohort and all of them (100%) had HITSs in TCD. In multivariable analysis, the presence of HITS (p=0.006) and intra-luminal thrombosis (p=0.02) were significant predictors of IEs.
Conclusions:
The presence of HITS detected by TCD is a strong predictor of IEs in patients with Carotid artery dissections. This highlights the clinical value of TCD in identifying high-risk patients and emphasizes the need for proactive management strategies to reduce the risk of future IEs in this subgroup.
