Cervical artery dissection after upper respiratory infection: clinical features and prognosis

Prior studies have suggested an association between cervical artery dissection (CAD) and upper respiratory tract infection, although evidence remains scarce. We aimed to compare the clinical features and outcomes of CAD with and without history of upper respiratory infection.

We conducted a secondary analysis of a multicenter, international, retrospective study including adult patients diagnosed with spontaneous CAD between January 2015 and June 2022. History of recent upper respiratory tract infection (HURI) was defined as symptoms of cough, fever, sneezing and throat soreness (at least two) within the 30 days preceding CAD diagnosis, as documented in patient medical records. Baseline characteristics and outcomes were compared between patients with and without HURI.

Among 4,023 patients with CAD, 251 (6.2%) had HURI. Multi-vessel involvement was nearly twice as frequent in this group (19.1% vs. 10.5%, p < 0.001). In multivariable analyses, HURI was associated with lower rates of occlusive dissection (30.1% vs. 35.9%, adjusted OR [95% CI]: 0.76 [0.57-1.00]) and reduced odds of presenting with ischemic stroke symptoms (55.9% vs. 65.7%, aOR [95% CI]: 0.60 [0.46-0.79]) or hemorrhagic transformation (1.6% vs. 4.9%, p = 0.02). At day 90, patients with HURI were more likely to achieve favorable functional outcome (mRS ≤ 2 93.0% vs. 85.2%, aOR [95% CI]: 2.12 [1.10-4.11]). No significant differences were found in mortality or CAD recurrence between groups.

Our findings suggest that CAD preceded by respiratory infection is associated with milder clinical presentation with better functional outcome, despite more frequent multivessel involvement.