Abstract TMP60: Association Between Pregnancy and Cervical Artery Dissection

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Setareh Salehi Omran ◽  
Neal Parikh ◽  
Sharon Poisson ◽  
Jennifer Armstrong ◽  
Alexander E Merkler ◽  
...  
Keyword(s):  
Risk Factor ◽  
Postpartum Period ◽  
Large Population ◽  
Control Period ◽  
Emergency Department Visits ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Administrative Claims ◽  
Increased Risk ◽  
Cervical Artery

Background and Purpose: Pregnancy is a risk factor for stroke. The mechanisms of stroke in pregnancy have not been well established. Cervical artery dissection may be one such mechanism, but it is unclear whether pregnancy is a risk factor for cervical artery dissection. Methods: We performed a cohort-crossover analysis using administrative claims data from all hospitalizations and emergency department visits involving nonfederal acute care hospitals in NY and FL between 2005-2015. We identified women ≥12 years old who were hospitalized for labor and delivery. Our outcome was cervical artery dissection, defined as carotid or vertebral artery dissection. We defined the period of risk as 6 months antepartum through 3 months postpartum. We compared each patient’s risk of dissection during this time period versus the corresponding 270-day period exactly 1 year later. Conditional Poisson models with robust standard errors were used to calculate incidence risk ratios (IRRs). Results: We identified 4,193,417 pregnancies among 3,061,413 women during our study period. There were 52 cases of cervical artery dissection during the peripartum period and 24 cases during the control period 1 year later. The incidence of cervical artery dissection was 12 (95% CI, 10-17) per million pregnancies versus 6 (95% CI, 4-9) per million patients during the control period 1 year later (IRR, 2.2; 95% CI, 1.3-3.5). Our findings were similar when we limited our outcome to cervical artery dissections complicated by ischemic stroke (IRR, 2.3; 95% CI, 1.1-5.1). Secondary analyses suggested that the heightened risk occurred in the peripartum and postpartum period (IRR,5.5; 95% CI, 2.6-11.7), not the antepartum period (IRR, 0.5; 95% CI, 0.2-1.2). Conclusions: In a large, population-based sample of women, pregnancy was associated with an increased risk of cervical artery dissection. This increased risk appeared to be limited to the peripartum and postpartum period.

Abstract TP107: Timing of Stroke Risk Following Cervical Artery Dissection

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nicholas A Morris ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Hooman Kamel
Keyword(s):  
Sensitivity Analysis ◽  
Stroke Risk ◽  
Emergency Department Visits ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Administrative Claims ◽  
Absolute Increase ◽  
Cervical Artery ◽  
Acute Dissection ◽  
The Absolute

Introduction: Cervical artery dissection is a common cause of stroke in young people. The temporal profile of stroke risk after cervical artery dissection remains uncertain. Methods: We performed a crossover-cohort study using administrative claims data on all emergency department visits and acute care hospitalizations from 2005-2011 in California, 2006-2013 in New York, and 2005-2013 in Florida. Using previously validated ICD-9-CM codes, we identified patients with a cervical artery dissection and no prior or concurrent stroke diagnosis. Previously validated diagnosis codes were used to identify the primary outcome of ischemic stroke. We compared the risk of stroke in successive 2-week periods during the 12 weeks after dissection versus the corresponding 2-week period 1 year later. Absolute risks increases were calculated using a Mantel-Haenszel estimator for matched data. In a sensitivity analysis, we limited our population to only patients that presented with typical symptoms of cervical artery dissection in order to ensure we identified patients with acute dissection. Results: We identified 2,791 patients with dissection. The absolute increase in stroke risk was 1.25% (95% CI, 0.84-1.67%) in the first 2 weeks after dissection compared to the same time period 1 year later. The absolute risk increase was 0.18% (95% CI 0.02-0.34%) during weeks 3-4, and was no longer significant during the remainder of the 12 week post-dissection period. Our findings were similar in a sensitivity analysis identifying patients who presented with typical symptoms of acute dissection. Conclusions: The increased risk of stroke following cervical artery dissection appears to be limited to the first 2 weeks.

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.

Migraine with Aura Is a Risk Factor for Cervical Artery Dissection: A Case-Control Study

2010 ◽  
Vol 30 (1) ◽  
pp. 36-40 ◽  
Author(s):  
V. Artto ◽  
T.M. Metso ◽  
A.J. Metso ◽  
J. Putaala ◽  
E. Haapaniemi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Migraine With Aura ◽  
Case Control Study ◽  
Case Control ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery ◽  
Control Study

The ICAM-1 E469K gene polymorphism is a risk factor for spontaneous cervical artery dissection

Neurology ◽  
2006 ◽  
Vol 66 (8) ◽  
pp. 1273-1275 ◽  
Author(s):  
M. Longoni ◽  
C. Grond-Ginsbach ◽  
A. J. Grau ◽  
J. Genius ◽  
S. Debette ◽  
...  
Keyword(s):  
Risk Factor ◽  
Gene Polymorphism ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery

scholarly journals Clinical Features of Patients With Cervical Artery Dissection and Fibromuscular Dysplasia

Stroke ◽  
2021 ◽  
Author(s):  
Sonia Bonacina ◽  
Mario Grassi ◽  
Marialuisa Zedde ◽  
Andrea Zini ◽  
Anna Bersano ◽  
...  
Keyword(s):  
Risk Factor ◽  
Odds Ratio ◽  
Clinical Characteristics ◽  
Fibromuscular Dysplasia ◽  
Vascular Pathology ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Risk Factor Profile ◽  
Cervical Artery ◽  
History Of

Background and Purpose: Observational studies have suggested a link between fibromuscular dysplasia and spontaneous cervical artery dissection (sCeAD). However, whether patients with coexistence of the two conditions have distinctive clinical characteristics has not been extensively investigated. Methods: In a cohort of consecutive patients with first-ever sCeAD, enrolled in the setting of the multicenter IPSYS CeAD study (Italian Project on Stroke in Young Adults Cervical Artery Dissection) between January 2000 and June 2019, we compared demographic and clinical characteristics, risk factor profile, vascular pathology, and midterm outcome of patients with coexistent cerebrovascular fibromuscular dysplasia (cFMD; cFMD+) with those of patients without cFMD (cFMD–). Results: A total of 1283 sCeAD patients (mean age, 47.8±11.4 years; women, 545 [42.5%]) qualified for the analysis, of whom 103 (8.0%) were diagnosed with cFMD+. In multivariable analysis, history of migraine (odds ratio, 1.78 [95% CI, 1.13–2.79]), the presence of intracranial aneurysms (odds ratio, 8.71 [95% CI, 4.06–18.68]), and the occurrence of minor traumas before the event (odds ratio, 0.48 [95% CI, 0.26–0.89]) were associated with cFMD. After a median follow-up of 34.0 months (25th to 75th percentile, 60.0), 39 (3.3%) patients had recurrent sCeAD events. cFMD+ and history of migraine predicted independently the risk of recurrent sCeAD (hazard ratio, 3.40 [95% CI, 1.58–7.31] and 2.07 [95% CI, 1.06–4.03], respectively) in multivariable Cox proportional hazards analysis. Conclusions: Risk factor profile of sCeAD patients with cFMD differs from that of patients without cFMD. cFMD and migraine are independent predictors of midterm risk of sCeAD recurrence.

Abstract P601: Influenza-Like Illness as a Short-Term Risk Factor for Arterial Dissections

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Stephanie Buchman Rutrick ◽  
Kelsey Lansdale ◽  
Jens Witsch ◽  
Alison P Seitz ◽  
Hooman Kamel ◽  
...  
Keyword(s):  
Risk Factor ◽  
Emergency Department Visits ◽  
Arterial Dissection ◽  
Artery Dissection ◽  
Administrative Claims ◽  
Short Term ◽  
Absolute Increase ◽  
Influenza Like Illness ◽  
The Absolute ◽  
One Year

Introduction: Arterial dissections often have no known identifiable risk factor. Whether infection/inflammation may play a role in the development of arterial dissection is uncertain. Hypothesis: Influenza-like illness (ILI) is associated with a heightened risk of arterial dissection. Methods: We performed a case-crossover analysis using administrative claims data on emergency department visits and acute care hospitalizations from 2006 to 2015 in NY and 2005-2015 in FL. We used previously validated International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify patients with ILI and arterial dissection. Arterial dissection included the composite of cervical artery dissection (carotid and vertebral), coronary artery dissection, and aortic dissection. We compared the risk of arterial dissection in successive 30-day periods after ILI versus the corresponding 30-day periods one year earlier. We used McNemar test for matched data to calculate the absolute risk increases. Results: We identified 2,838,178 patients with ILI. The absolute increase in arterial dissection was 0.005% (95% CI, 0.004-0.006%) in the thirty days post ILI compared with the same period one year earlier (OR 3.3, 95% CI, 2.5-4.4). The absolute increase in arterial dissection attenuated over successive 30-day periods after ILI and was no longer significant after 120 days post ILI (Figure). Our results were similar in secondary analyses evaluating cervical, coronary, and aortic dissections separately. Conclusions: ILI is associated with a heightened short-term risk of arterial dissection. Further studies are warranted to evaluate mechanisms of how ILI and/or related inflammation leads to a heightened risk of systemic and cerebrovascular dissections.

scholarly journals Migraine, migraine aura, and cervical artery dissection: A systematic review and meta-analysis

Cephalalgia ◽  
2011 ◽  
Vol 31 (8) ◽  
pp. 886-896 ◽  
Author(s):  
Pamela M Rist ◽  
Hans-Christoph Diener ◽  
Tobias Kurth ◽  
Markus Schürks
Keyword(s):  
Systematic Review ◽  
Migraine With Aura ◽  
Meta Analysis ◽  
Current Evidence ◽  
Artery Dissection ◽  
Effect Estimate ◽  
Cervical Artery Dissection ◽  
Migraine Aura ◽  
Increased Risk ◽  
Cervical Artery

Objective: We evaluated the current evidence on the association between migraine, including aura status, and cervical artery dissection. Methods: We performed a systematic review and meta-analysis of studies investigating the association between migraine or migraine subtypes (e.g. migraine with aura) and cervical artery dissection published through October 2010. Results: We identified five case-control studies investigating the association between migraine and cervical artery dissection. In pooled analysis, migraine doubled the risk of cervical artery dissection (pooled odds ratio [OR] = 2.06, 95% confidence interval [CI] 1.33–3.19). All studies allowed evaluation of migraine aura status. While the effect estimate for migraine without aura (pooled OR = 1.94, 95% CI 1.21–3.10) was similar to overall migraine, the association was weaker for migraine with aura (pooled OR = 1.50, 95% CI 0.76–2.96). However, there is no evidence that aura status significantly modifies the association between migraine and cervical artery dissection (meta-regression on aura status p = .58). The risk does not appear to differ between women and men; however, only few studies presented gender-specific data. Heterogeneity among studies was low to moderate. Conclusion: In this meta-analysis migraine is associated with a two-fold increased risk of cervical artery dissection. This risk does not appear to significantly differ by migraine aura status or gender.

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.

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