Vascular risk factors and morphometric data in cervical artery dissection: a case-control study

ObjectiveRecent anticoagulation trials in all-comer cryptogenic stroke patients have yielded equivocal results, reinvigorating the focus on identifying reproducible markers of an atrial myopathy. We investigated the role of excessive premature atrial complexes (PACs) in ischaemic stroke, including cryptogenic stroke and its association with vascular risk factors.Methods and resultsA case–control study was conducted utilising a multicentre institutional stroke database to compare 461 patients with an ischaemic stroke or transient ischaemic attack (TIA) with a control group consisting of age matched patients without prior history of ischaemic stroke/TIA. All patients underwent 24-hour Holter monitoring during the study period and atrial fibrillation was excluded. An excessive PAC burden, defined as ≥200 PACs/24 hours, was present in 25.6% and 14.7% (p<0.01), of stroke/TIA and control patients, respectively. On multivariate regression, excessive PACs (OR 1.97; 95% CI 1.29 to 3.02; p<0.01), smoking (OR 1.58; 95% CI 1.06 to 2.36; p<0.05) and hypertension (OR 1.53; 95% CI 1.07 to 2.17; p<0.05) were independently associated with ischaemic stroke/TIA. Excessive PACs remained the strongest independent risk factor for the cryptogenic stroke subtype (OR 1.95; 95% CI 1.16 to 3.28; p<0.05). Vascular risk factors that promote atrial remodelling, increasing age (≥75 years, OR 3.64; 95% CI 2.08 to 6.36; p<0.01) and hypertension (OR 1.54; 95% CI 1.01 to 2.34; p<0.05) were independently associated with excessive PACs.ConclusionsExcessive PACs are independently associated with cryptogenic stroke and may be a reproducible marker of atrial myopathy. Prospective studies assessing their utility in guiding stroke prevention strategies may be warranted.

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Is It Possible to Recognize Cervical Artery Dissection on Stroke Brain MR Imaging? A Matched Case-Control Study

American Journal of Neuroradiology ◽

10.3174/ajnr.a2553 ◽

2011 ◽

Vol 32 (5) ◽

pp. 869-873 ◽

Cited By ~ 16

Author(s):

O. Naggara ◽

F. Soares ◽

E. Touze ◽

D. Roy ◽

X. Leclerc ◽

...

Keyword(s):

Mr Imaging ◽

Case Control Study ◽

Case Control ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Cervical Artery ◽

Matched Case ◽

Matched Case Control Study ◽

Control Study

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Cervical artery dissection-related stroke: Vascular risk factors may have a role

Annals of Indian Academy of Neurology ◽

10.4103/aian.aian_403_19 ◽

2019 ◽

Vol 0 (0) ◽

pp. 0 ◽

Cited By ~ 1

Author(s):

Salil Gupta ◽

VSharath Kumar

Keyword(s):

Risk Factors ◽

Vascular Risk Factors ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Vascular Risk ◽

Cervical Artery

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Abstract MP51: Association Between Cervical Artery Dissection and the Risk of Aortic Dissection

Stroke ◽

10.1161/str.52.suppl_1.mp51 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jens Witsch ◽

Saad Mir ◽

Neal S Parikh ◽

Santosh Murthy ◽

Hooman Kamel ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Secondary Analysis ◽

Vascular Risk Factors ◽

Emergency Department Visits ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Vascular Risk ◽

Increased Risk ◽

Cervical Artery

Background: Cervical artery dissection (CAD) often affects young, otherwise healthy people. Few data exist on whether patients with CAD face an increased vulnerability to aortic dissection. Herein we tested the hypothesis that CAD is associated with an increased risk of aortic dissection. Methods: We performed a retrospective cohort study using statewide administrative claims data from all Emergency Department visits and admissions at nonfederal hospitals in Florida from 2005 to 2015 and New York from 2006 to 2015. We used previously validated International Classification of Disease, Ninth Revision, Clinical Modification codes (ICD-9-CM) to identify patients with CAD and aortic dissection. Patients with prevalent aortic dissection were excluded. Our exposure variable was CAD and the outcome was incident aortic dissection after discharge from CAD hospitalization. Survival statistics were used to calculate incidence rates and Cox proportional hazards analysis was used to determine the association between CAD and aortic dissection while adjusting for demographics and vascular risk factors. In a secondary analysis, we excluded patients who had a traumatic CAD, defined as having concomitant ICD-9-CM codes for head or neck trauma at the time of CAD. Results: Among 19,715,114 patients, 4,537 (0.02%) had a CAD. The mean age of patients with CAD was 52.3±16.4 years. During 4.2±3.1 years of follow up, 16,571 patients were diagnosed with an aortic dissection (0.08%). The incidence of aortic dissection was 2.5 (95% CI, 1.7-3.7) per 1,000 patients per year in those with CAD versus 0.2 (95% CI, 0.2-0.2) per 1,000 patients per year in those without CAD. After adjustment for demographics and vascular risk factors, we found that CAD was associated with subsequent aortic dissection (HR 3.0, 95% CI, 2.1-4.5). Our results were similar in a secondary analysis excluding patients with traumatic CAD (HR 3.3, 95% CI, 2.2-4.8). Conclusions: In a large population-based cohort, we found that CAD was associated with a 3-fold increased risk of aortic dissection. Future studies should evaluate the utility of performing screening aortic imaging in patients with CAD.

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Association of Vascular Risk Factors With Cervical Artery Dissection and Ischemic Stroke in Young Adults

Circulation ◽

10.1161/circulationaha.110.000125 ◽

2011 ◽

Vol 123 (14) ◽

pp. 1537-1544 ◽

Cited By ~ 74

Author(s):

Stéphanie Debette ◽

Tiina Metso ◽

Alessandro Pezzini ◽

Shérine Abboud ◽

Antti Metso ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischemic Stroke ◽

Vascular Risk Factors ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Vascular Risk ◽

Stroke In Young Adults ◽

Cervical Artery ◽

Stroke In Young

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Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.2005.063107 ◽

2006 ◽

Vol 77 (1) ◽

pp. 95-97 ◽

Cited By ~ 45

Author(s):

A Pezzini

Keyword(s):

Risk Factor ◽

Arterial Hypertension ◽

Case Control Study ◽

Case Control ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Cervical Artery ◽

Control Study

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Acute Ischemic Stroke on Cancer Patients, a Distinct Etiology? A Case-Control Study

Acta Médica Portuguesa ◽

10.20344/amp.6156 ◽

2015 ◽

Vol 28 (5) ◽

pp. 613 ◽

Cited By ~ 5

Author(s):

Ana Carrilho Romeiro ◽

Anabela Valadas ◽

José Marques

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cancer Patients ◽

Case Control Study ◽

Case Control ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Control Study ◽

Active Cancer

Introduction: It is still unclear whether the etiology of ischemic stroke differs between cancer and non-cancer patients. Stroke and cancer share common modifiable risk factors but evidence suggests that cancer patients have specific conditions that increase the risk of stroke. Our goal was to compare the etiology of ischemic stroke in cancer and non-cancer patients. Material and Methods: Case-control study conducted in patients admitted to a stroke unit between January 2007 and December 2012. Cases had a concomitant diagnosis of cancer and acute ischemic stroke, controls of only stroke. Age, gender, vascular risk factors and etiology were compared between groups. Results: Fifty-six cases were identified; 64.3% were men with a mean age of 71 years; 21 patients had evidence of active cancer. Gastrointestinal cancer (25.9%) was the most common; 151 controls were included matched for gender and age. Common modifiable vascular risk factors, between groups (cases versus controls) were not significantly different, except for diabetes mellitus, more frequent in the control group (16.1% vs 33.8%, p = 0.02). Previous thrombotic events were more frequent in the cancer cohort (8.9% vs 0.7%, p = 0.007). Other determined etiology subtype (TOAST classification) was more frequent in cancer patients when compared to controls (13.0% vs 0.8%, p < 0.01), and a hypercoagulable state was significantly more prevalent in active cancer patients. Discussion: In our case-control study two subsets of cancer patients were delineated. In a subgroup, cancer and stroke co-exist, sharing traditional vascular risk factors. In another subset of patients, stroke appears to be directly related to the presence of a malignancy, where hypercoagulopathy turns out to be a decisive mechanism. Conclusion: In clinical grounds, hypercoagulopathy as stroke etiology should prompt the physician to screen the patient for occult cancer.

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Cervical Artery Dissection in Patients of African Ancestry

Cerebrovascular Diseases ◽

10.1159/000494704 ◽

2018 ◽

Vol 46 (5-6) ◽

pp. 218-222 ◽

Cited By ~ 1

Author(s):

Ilana E. Green ◽

Shareena A. Rahman ◽

Debra L. Owens ◽

Michèle M. Sale ◽

Lillian J. Currie ◽

...

Keyword(s):

Risk Factors ◽

Risk Allele ◽

African Ancestry ◽

Vascular Risk Factors ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Vascular Risk ◽

Young Stroke ◽

Cervical Artery ◽

Clinical Profiles

Background and Purpose: The majority of published data in cervical artery dissection (CeAD), a common cause of stroke in young adults, derive from populations of European ancestry (EA), including a recent genome-wide study identifying an association with the rs9349379 polymorphism of the PHACTR1 gene. Little is known about CeAD in individuals of African ancestry (AA) despite robust epidemiological data showing increased risk of stroke at younger ages. We hypothesize that AA patients with CeAD have different epidemiology and clinical profiles compared to those of EA, and a different genetic architecture related to rs9349379 of the PHACTR1 gene. Methods: We searched a single-center database of CeAD to identify AA and EA patients. We compared differential prevalence of CeAD versus all young stroke between AA and EA patients. We characterized clinical profiles via electronic medical record review. Data include descriptive statistics reported as medians or percentages. We also obtained publicly available allele frequencies of rs9349379 in AA and EA populations. Results: AA patients comprise 7% of CeAD cases and 27% of young stroke cases while EA patients comprise 90% of CeAD cases and 70% of young stroke cases. Prevalence of hypertension, diabetes mellitus, and hyperlipidemia were 74, 30, and 50%, respectively, in AA patients compared to 37, 6, and 25% in EA patients. Allele frequencies for the CeAD risk allele, rs9349379(A), are higher in AA populations compared to EA populations. Conclusion: AA patients represent a smaller proportion of CeAD cases compared to young stroke cases at our center. AA patients suffering CeAD have higher prevalence of both vascular risk factors and frequency of the CeAD risk allele compared to EA patients. These findings suggest a complex interplay between traditional vascular risk factors and genetic predisposition underlying CeAD pathogenesis. Further prospective research is needed to clarify these associations and disparities.

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