Cervical Artery Dissection in Patients of African Ancestry

2018 ◽  
Vol 46 (5-6) ◽  
pp. 218-222 ◽  
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.

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

Stroke ◽  
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.

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

Circulation ◽  
2011 ◽  
Vol 123 (14) ◽  
pp. 1537-1544 ◽  
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

scholarly journals Cervical Artery Dissection in Young Adults in the Stroke in Young Fabry Patients (sifap1) Study

2015 ◽  
Vol 39 (2) ◽  
pp. 110-121 ◽  
Author(s):  
Bettina von Sarnowski ◽  
Ulf Schminke ◽  
Ulrike Grittner ◽  
Franz Fazekas ◽  
Christian Tanislav ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clinical Features ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Vascular Risk ◽  
Similar Frequency ◽  
Cervical Artery ◽  
History Of ◽  
Stroke In Young

Background: Patients with carotid artery dissection (CAD) have been reported to have different vascular risk factor profiles and clinical outcomes to those with vertebral artery dissection (VAD). However, there are limited data from recent, large international studies comparing risk factors and clinical features in patients with cervical artery dissection (CeAD) with other TIA or ischemic stroke (IS) patients of similar age and sex. Methods: We analysed demographic, clinical and risk factor profiles in TIA and IS patients ≤55 years of age with and without CeAD in the large European, multi-centre, Stroke In young FAbry Patients 1 (sifap1) study. Patients were further categorised according to age (younger: 18-44 years; middle-aged: 45-55 years), sex, and site of dissection. Results: Data on the presence of dissection were available in 4,208 TIA and IS patients of whom 439 (10.4%) had CeAD: 196 (50.1%) had CAD, 195 (49.9%) had VAD, and 48 had multiple artery dissections or no information regarding the dissected artery. The prevalence of CAD was higher in women than in men (5.9 vs. 3.8%, p < 0.01), whereas the prevalence of VAD was similar in women and men (4.6 vs. 4.7%, n.s.). Patients with VAD were younger than patients with CAD (median = 41 years (IQR = 35-47 years) versus median = 45 years (IQR = 39-49 years); p < 0.01). At stroke onset, about twice as many patients with either CAD (54.0 vs. 23.1%, p < 0.001) or VAD (63.4 vs. 36.6%, p < 0.001) had headache than patients without CeAD and stroke in the anterior or posterior circulation, respectively. Compared to patients without CeAD, hypertension, concomitant cardiovascular diseases and a patent foramen ovale were significantly less prevalent in both CAD and VAD patients, whereas tobacco smoking, physical inactivity, obesity and a family history of cerebrovascular diseases were found less frequently in CAD patients, but not in VAD patients. A history of migraine was observed at a similar frequency in patients with CAD (31%), VAD (27.8%) and in those without CeAD (25.8%). Conclusions: We identified clinical features and risk factor profiles that are specific to young patients with CeAD, and to subgroups with either CAD or VAD compared to patients without CeAD. Therefore, our data support the concept that certain vascular risk factors differentially affect the risk of CAD and VAD.

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

Stroke ◽  
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.

Abstract TP166: The Topmost Modifiable Risk Factors for Stroke Among People of African Ancestry

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mayowa O Owolabi ◽  
Fred S Sarfo ◽  
Onoja Akpa ◽  
Mulugeta Gebregziabher ◽  
Rufus Akinyemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
African Ancestry ◽  
Vascular Risk Factors ◽  
Systematic Evaluation ◽  
Modifiable Risk Factors ◽  
Large Artery ◽  
Vascular Risk ◽  
Geographical Variations ◽  
Catchment Areas ◽  
The Impact

Background: Regional and geographical variations exist in stroke burden and risk factor distribution. The unique and dominant risk factors for stroke among people of African ancestry where the burden of stroke is escalating, are poorly understood. Such information is crucial in prioritizing tailor-made interventions to tackle the menace of stroke in developing countries. Purpose: We aimed to identify and quantify the contributions of the topmost modifiable risk factors for stroke occurrence in people of African ancestry within the context of the Stroke Investigative Research and Educational Network (SIREN), the largest study of stroke in Africa. Methods: The SIREN study is an ongoing, multicenter, case-control study involving several sites in Nigeria and Ghana. Cases included adults aged >18 years with first clinical stroke within 8 days of current symptom onset with CT scan confirmation. Controls were stroke-free adults, mostly from the communities in the catchment areas of the SIREN hospitals where cases were recruited. A systematic evaluation of traditional vascular risk factors as well as lifestyle and behavioral factors were assessed for cases and controls. Results: 1,638 cases and 1,653 controls with mean ages of 58.52 and 57.76 years respectively were recruited. Ischemic and hemorrhagic stroke types constituted 62.4% and 36.1% of stroke respectively. Among ischemic stroke subjects, 45.7%, 36.3%, 13.6%, 1.0% and 3.4% had small-vessel, large-artery atherosclerosis, cardio-embolic, others and unknown subtypes according to the TOAST classification. Leading vascular risk factors identified among stroke subjects compared with controls were hypertension- 79.3% vs 34.6%, p<0.001; Dyslipidemia 20.8% vs 6.6%, p<0.001; Diabetes mellitus- 24.4% vs 12.8% and history of cardiac diseases 15.4% vs 7.9%, p<0.001. Adjusted ORs (95% CI) for hypertension, dyslipidemia, cardiac disease and diabetes among stroke subjects compared with controls were 6.43 (5.84-7.54), 2.08 (1.61-2.69), 1.48 (1.15-1.91) and 1.29 (1.05-1.60) respectively. Conclusion: Implementation of interventions towards mitigating the impact of vascular risk factors at the population level would be essential in curtailing the growing burden of stroke in Africans.

Abstract WP164: Spontaneous Cervical Artery Dissection in Individuals of African Ancestry

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Ilana E Green ◽  
Debra L Owens ◽  
Tyler N Lescure ◽  
Shareena A Rahman ◽  
Bradford B Worrall ◽  
...  
Keyword(s):  
African Ancestry ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery

scholarly journals Cervical artery dissection in patients ≥60 years

Neurology ◽  
2017 ◽  
Vol 88 (14) ◽  
pp. 1313-1320 ◽  
Author(s):  
Christopher Traenka ◽  
Daphne Dougoud ◽  
Barbara Goeggel Simonetti ◽  
Tiina M. Metso ◽  
Stéphanie Debette ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Age Groups ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Age Group ◽  
Presenting Symptoms ◽  
Cervical Artery ◽  
Secondary Analyses ◽  
Study Population

Objective:In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years.Methods:We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients–Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated.Results:Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33–0.66]), headache (ORadjusted 0.58 [0.42–0.79]), mechanical trigger events (ORadjusted 0.53 [0.36–0.77]), and migraine (ORadjusted 0.58 [0.39–0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1–2.10]) and hypertension (ORadjusted 3.08 [2.25–4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0–2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]).Conclusion:In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.

Cervical artery dissection?clinical features, risk factors, therapy and outcome in 126 patients

2003 ◽  
Vol 250 (10) ◽  
pp. 1179-1184 ◽  
Author(s):  
Rainer Dziewas ◽  
Carsten Konrad ◽  
Bianca Dr�ger ◽  
Stefan Evers ◽  
Michael Besselmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Features ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery
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