Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation

Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. Methods: A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014–31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). Results: Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. Conclusion: Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04–98.04), 95.64% (95% CI 92.87–97.35), and 94.5% (95% CI 91.12–97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.

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Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

Scandinavian Journal of Surgery ◽

10.1177/14574969211000546 ◽

2021 ◽

pp. 145749692110005

Author(s):

S. Acosta ◽

F. B. Gonçalves

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Conservative Therapy ◽

Case Series ◽

Celiac Artery ◽

Artery Dissection ◽

Covered Stents ◽

Bowel Infarction

Background and Aims: There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited. Material and Methods: The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis. Results and Conclusions: Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.

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Spontaneous coronary artery dissection in association with cabergoline therapy

BMJ Case Reports ◽

10.1136/bcr-2020-240022 ◽

2021 ◽

Vol 14 (2) ◽

pp. e240022

Author(s):

Zia Saleh ◽

Susan Koshy ◽

Vaninder Sidhu ◽

Andrea Opgenorth ◽

Janek Senaratne

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Cardiac Risk ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Coronary Syndrome ◽

Ergot Derivative

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline—an ergot derivative and dopamine agonist that may induce vasospasm—has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.

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The Usefulness of MDCT Angiography in the Diagnosis of Vertebrobasilar Artery Dissection

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2007.56.2.101 ◽

2007 ◽

Vol 56 (2) ◽

pp. 101

Author(s):

Gyeong Sik Jeon ◽

Ho Sung Kim ◽

Sun Yong Kim ◽

Yong Sam Shin ◽

Oh Young Bang

Keyword(s):

Artery Dissection ◽

Mdct Angiography ◽

Vertebrobasilar Artery

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Abstract 49: Male Sex is Associated With Cervical Artery Dissection in Patients With Fibromuscular Dysplasia

Stroke ◽

10.1161/str.51.suppl_1.49 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Charlotte Arnaud ◽

Marion Boulanger ◽

Aurélien Lorthioir ◽

Laurence Amar ◽

Arshid Azarine ◽

...

Keyword(s):

Risk Factors ◽

Fibromuscular Dysplasia ◽

Pooled Analysis ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

University Hospitals ◽

The Us ◽

Cervical Artery ◽

History Of ◽

Male Sex

Background: Cervical artery dissection (CeAD) is one of the most frequent manifestations of fibromuscular dysplasia (FMD). However, the risk factors for CeAD are unknown. We investigated factors associated with CeAD in the ARCADIA (Assessment of Renal and Cervical Artery Dysplasia) registry and performed a pooled analysis of published and unpublished data. Methods: Patients included were women and men ≥18 years, diagnosed with renal, cervical, or intracranial artery FMD, prospectively recruited at 16 university hospitals in France and Belgium. Diagnosis of CeAD was established by stroke specialists in each participating center, according to standard diagnostic criteria. Associations between CeAD and potential determinants were assessed by calculations of crude and adjusted odds ratios. Results: Among 469 patients (415 women) with FMD, 68 (14.5%) had CeAD. CeAD patients were younger, more likely to be men and to have a history of migraine, and less likely to have a history of hypertension, than non-CeAD patients. In the multivariate analysis, male sex (OR=2.75 ; CI95% 1.39-5.46), history of migraine (OR=1.93 ; 1.08-3.44), age >50 years (OR=0.41 ; 0.23-0.74), history of hypertension (OR=0.35 ; 0.19-0.63), and the number of vascular beds involved by FMD >=3 (OR=2.46 ; 1.13-5.35) remained significantly associated with CeAD. We collected data from 2 published studies and unpublished data from the US and the European Registries. There was no overlap between studies. In a pooled analysis (289 CeAD in 1933 patients), male sex was significantly associated with CeAD (pooled OR=2.04 ; 1.41-2.95, I2=0%, Figure). Conclusion: In patients with FMD, male sex and multisite involvement are associated with of CeAD, in addition to other previous known risk factors.

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CARDIOVASCULAR DISEASES: PREVALENCE, RISK FACTORS (LITERATURE REVIEW)

Vestnik ◽

10.53065/kaznmu.2021.91.74.014 ◽

2021 ◽

pp. 84-92

Author(s):

М.О. Мустафина ◽

А. Телжанов ◽

З.Н. Лигай

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Plaque Rupture ◽

Young Patients ◽

Microvascular Dysfunction ◽

Artery Dissection ◽

Variant Angina ◽

Coronary Artery Dissection ◽

Plaque Erosion

Мы провели поиск в PubMed статей, опубликованных с 1980 по 2020, используя термины «острый инфаркт миокарда», «молодой», «разрыв бляшки», эрозия бляшки, спонтанное расслоение коронарной артерии (SCAD), коронарный вазоспазм», «вариантная стенокардия или стенокардия Принцметала», «лекарственный инфаркт миокарда», «миокардит», «коронарная эмболия», «микрососудистая дисфункция», «MINOCA», а также обзор всех опубликованных исследований. Используя данные этого поиска, мы стремимся проинформировать читателей о распространенности, факторах риска, проявлениях и лечении острого инфаркта миокарда у молодых пациентов, а также подробно рассказать о специальных подгруппах с диагностическими и терапевтическими проблемами. We searched PubMed for articles published from 1980 to 2020 using the terms acute myocardial infarction, young, plaque rupture, plaque erosion, spontaneous coronary artery dissection (SCAD), coronary vasospasm, variant angina or angina pectoris. Prinzmetal, drug myocardial infarction, myocarditis, coronary embolism, microvascular dysfunction, MINOCA, and a review of all published studies. Using the data from this search, we aim to inform readers about the prevalence, risk factors, manifestations and treatment of acute myocardial infarction in young patients, as well as detail the special subgroups with diagnostic and therapeutic problems.

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Vertebrobasilar artery calcification: Prevalence and risk factors in the general population

Atherosclerosis ◽

10.1016/j.atherosclerosis.2019.05.001 ◽

2019 ◽

Vol 286 ◽

pp. 46-52 ◽

Cited By ~ 8

Author(s):

Janine E. van der Toorn ◽

Sophie R. Engelkes ◽

M. Kamran Ikram ◽

M. Arfan Ikram ◽

Meike W. Vernooij ◽

...

Keyword(s):

Risk Factors ◽

General Population ◽

Vertebrobasilar Artery

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P715 When "wait and see" is the best option: a case report of a spontaneous coronary artery dissection

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.388 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Castelo ◽

T Silva ◽

R Ramos ◽

A Fiarresga ◽

R Moreira ◽

...

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Coronary Syndrome ◽

Luminal Narrowing ◽

Angio Ct ◽

Spontaneous Dissection

Abstract Introduction Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and is now being identified more frequently, in part because of increased awareness. Case report We present the case of a 63-year-old female, without cardiovascular risk factors or relevant past medical history. She complained of atypical chest pain in the last year. The patient was admitted due to acute chest pain at rest, hemodynamically stable, with unremarkable physical examination, including absence of heart failure signs. The EKG revealed a dynamic ST depression in leads V4-V6. The peak of high sensitivity troponin I was 13744pg/mL (ULN< 15.6) and CK 874U/l (ULN <168). The echocardiogram showed preserved left ventricular ejection fraction and hypokinesia of mid-apical segments of anterior wall. Considering the diagnosis of NSTEMI the patient underwent coronary angiography that revealed luminal narrowing of 70% in left main artery, 70% in proximal anterior descending artery (LAD) and 99% in first obtuse marginal. Given the absence of cardiovascular risk factors, the smooth angiographic appearance of coronary lesions and absence of calcium, we suspected of spontaneous dissection or vasculitis. Considering the absence of angina revascularization was delayed. A first coronary angio-CT confirmed the luminal narrowing and suggested a spontaneous dissection. Two weeks later the coronariography and the angio-CT were repeated with a significant improvement, showing only intermediate stenosis of proximal LAD. The additional imaging study revealed a 45mm ascending aortic dilation and a left primitive carotid stenosis without other vascular territory alterations, excluding fibromuscular dysplasia. The auto-immune study was unremarkable. With all these results it was assumed the diagnosis of a spontaneous coronary artery dissection and the patient was discharged asymptomatic under single antiplatelet therapy and Rivaroxaban. Three months later a new coronary angio-CT showed no significant coronary artery stenosis and the patient was asymptomatic. Discussion and conclusion The recognition of spontaneous coronary artery dissection is essential to the correct management of these cases because, unlike acute coronary syndrome due to atherosclerotic disease, the results of revascularization in these patients are suboptimal and conservative management is probably the best option. Abstract P715 Figure. angio-CT

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