Related Experiment Videos
Recurrence of cervical artery dissection. A prospective study of 81 patients
C Bassetti1, A Carruzzo, M Sturzenegger
1Department of Neurology, University Hospital, Inselspital, Bern, Switzerland.
Insights
Recurrence of spontaneous cervical artery dissection (SCAD) is uncommon, affecting 4% of patients. Delayed dissections can occur at the original site, highlighting the need for continued monitoring.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Spontaneous cervical artery dissection (SCAD) is a leading cause of stroke in young individuals.
- Recurrence of SCAD, particularly at the previously affected site, is infrequently documented.
- Limited data exists on the long-term recurrence rates of SCAD.
Observation:
- A prospective study followed 81 patients with carotid or vertebral artery dissection.
- Diagnosis was confirmed via angiography and/or MRI.
- Mean follow-up was 34 months, with repeated clinical and ultrasound examinations.
Findings:
- Of 74 eligible patients, 4% experienced recurrent carotid artery dissection.
- Recurrences occurred 16 months to 4 years post-initial event, presenting as head/neck pain or transient ischemic attack.
- No recurrent vertebral artery dissections were observed; one carotid recurrence was at the original dissection site.
Implications:
- SCAD recurrence is uncommon and generally benign.
- Delayed recurrence is more frequent than previously thought.
- Recurrence can manifest at the site of the initial dissection, suggesting potential for long-term monitoring needs.
Background And Purpose:
Spontaneous cervical artery dissection (SCAD) is a common cause of stroke in the young; however, its recurrence has been rarely studied. Recurrent SCAD at the level of the previously dissected vessel has been reported in only six patients.
Methods:
We prospectively evaluated and followed a series of 81 patients seen in our center with carotid (n = 66) or vertebral (n = 15) artery dissection, in whom the diagnosis was confirmed by angiography, MRI, or both. Repeated clinical and ultrasound examinations were performed in all patients during a mean follow-up of 34 months (range, 12 to 57 months).
Results:
Three patients died of the consequences of stroke, and four patients were unavailable for follow-up. Three of the remaining 74 patients (4%) had a recurrent carotid dissection while under prophylaxis with aspirin (n = 2) or anticoagulation (n = 1). None of the patients had a recurrent vertebral dissection. Recurrent carotid dissection occurred 16 months to 4 years after the first episode and presented with acute head and neck pain (n = 2) and hemispheric transient ischemic attack (n = 1). In one patient recurrence was documented by Doppler and MRI at the level of the first dissection.
Conclusions:
We confirm that recurrence of SCAD is uncommon and usually represents a benign condition. Delayed recurrence seems to be more common than previously suggested and can occur at the level of the previously dissected vessel.