Recanalization After Acute Cervical Artery Dissection: A Multicenter International Study

The rates and factors associated with complete recanalization after cervical artery dissection (CeAD) have not been comprehensively quantified in large cohorts. We sought to determine the 6-month rate of complete recanalization in CeAD, clinical and imaging factors associated with recanalization, and risk of recurrent ischemic stroke based on recanalization status.

This was a planned subanalysis of the Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection study, a multicenter retrospective cohort including patients with imaging-confirmed CeAD diagnosed between January 2015 and June 2022 at 63 sites worldwide. For this analysis, we included 1,095 patients with single-vessel CeAD causing stenosis at presentation who had available follow-up vascular imaging at 6 months after CeAD. The primary outcome was complete recanalization within 6 months after CeAD. Clinical and imaging variables, as well as recurrent stroke, were compared between patients with and those without complete recanalization. Factors independently associated with complete recanalization were identified using multivariable logistic regression. Time to complete recanalization was analyzed using an accelerated failure time Weibull model.

Among 1,095 included patients (median age 45 years; 46.7% female), 634 (57.9%) achieved complete recanalization by 6 months. In multivariable analysis, each additional year of age was associated with lower odds of complete recanalization (odds ratio [OR] 0.97 per year; 95% CI 0.96-0.98; p < 0.001). Diabetes (OR 0.46; 95% CI 0.27-0.81; p = 0.006), active smoking (OR 0.69; 95% CI 0.50-0.95; p = 0.025), and complete occlusion at presentation (OR 0.44; 95% CI 0.32-0.59; p < 0.001) were independently associated with lower odds of complete recanalization. Complete occlusion at presentation was associated with both longer time to, and lower rates of, complete recanalization. We observed no effect of antithrombotic regimen (antiplatelet therapy vs anticoagulation) on complete recanalization. Incomplete recanalization was associated with a nonsignificant numerically higher proportion of recurrent stroke (5.4% vs 3.5%; p = 0.064).

Almost 60% of patients with CeAD achieved complete vessel recanalization by 6 months. Older age, diabetes, smoking, and complete occlusion at presentation were independently associated with incomplete recanalization. Further study is required to determine whether these findings may help guide tailored imaging surveillance and secondary prevention strategies.