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

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 WP179: Rate of Pulmonary Embolism After Cerebral Venous Thrombosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ava L Liberman ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Michael P Lerario ◽  
Steven R Messe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Vascular Risk Factors ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Cerebral Vein ◽  
Vascular Risk ◽  
Index Hospitalization ◽  
Increased Risk

Introduction: Cerebral vein thrombosis (CVT) is associated with an increased risk of subsequent venous thromboembolism. It is unknown whether the risk of pulmonary embolism (PE) after CVT is similar to that of PE after deep venous thrombosis (DVT). Methods: We performed a retrospective cohort study using administrative claims data from all emergency department visits and hospitalizations in California from 2005-2011, New York from 2006-2013, and Florida from 2005-2013. We identified patients with CVT or DVT as well as the primary outcome of PE using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM ) codes. In order to minimize misclassification error, patients with both CVT and DVT during the same index hospitalization were excluded and patients with CVT were censored at the time of development of DVT and vice versa. Kaplan-Meier survival statistics and Cox proportional hazards models were used to compare the risk of PE after CVT versus after DVT while adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index. Results: We identified 4,450 patients with CVT and 217,589 patients with DVT. During a mean follow-up of 2.0 (±1.7) years, 124 patients with DVT developed a PE and 18,698 patients with DVT developed a PE. Patients with CVT were younger (mean age 45 vs 63), more often female (71% vs 52%), more often pregnant, and had fewer vascular risk factors than patients with DVT. During the index hospitalization, the rate of PE was 1.5% (95% confidence interval [CI], 1.1-1.8%) in patients with CVT and 6.2% (95% CI, 6.1-6.3%, p<0.001) in patients with DVT. By 5 years, the cumulative rate of PE after CVT was 3.7% (95% CI, 3.0-4.4%) compared to 10.5% (95% CI, 10.3-10.6%, p<0.001) after DVT. After adjustment for demographics and comorbidities, CVT was associated with a significantly lower hazard of PE when compared to DVT (hazard ratio, 0.31; 95% CI, 0.26-0.38). Conclusion: In a large, heterogeneous population, we found that the risk of PE after CVT was significantly lower than that of PE after DVT. Among patients with CVT, the greatest risk for PE was apparent during the index hospitalization.

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.

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.

NCMP-06. THE RISK AND BURDEN OF THROMBOEMBOLIC AND HEMORRHAGIC EVENTS IN PATIENTS WITH MALIGNANT GLIOMA RECEIVING BEVACIZUMAB

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi148-vi148
Author(s):  
Alexander Ou ◽  
Heather Lin ◽  
Ying Yuan ◽  
Charles Bornstein ◽  
Kristin Alfaro-Munoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Univariate Analysis ◽  
Vascular Complications ◽  
Concurrent Chemotherapy ◽  
Vascular Risk Factors ◽  
Competing Risk ◽  
Vascular Risk ◽  
Acute Hemorrhage ◽  
Increased Risk

Abstract BACKGROUND Patients with high-grade gliomas (HGG) often receive anti-angiogenic therapy with bevacizumab to slow disease progression and/or palliate neurological symptoms. Bevacizumab has been associated with an increased risk of two major vascular complications: venous thromboembolism (VTE) and intracranial hemorrhage (ICH). We sought to identify clinical, pathologic, and radiographic variables correlated with risk of either event occurring in patients with HGG receiving bevacizumab. METHODS We retrospectively identified 94 patients with HGG who received bevacizumab at our center from 2015-2021. Variables included demographics, performance status, IDH, MGMT, vascular risk factors, baseline anti-coagulant/anti-platelet use, concurrent chemotherapy, and presence of macrobleeds on MRI (&gt;1 cm3 susceptibility) at the time of bevacizumab initiation. We conducted competing risk analysis using subdistribution hazard models with death as competing risk for ICH or VTE. The effects of covariates on the incidence of hemorrhage or VTE were evaluated in univariate and multivariate settings. RESULTS Of 94 patients, 36 (38.3%) and 27 (28.7%) developed VTE and ICH, respectively. 31 (33%) did not develop either. ICH and VTE events occurred after a mean of 4.46 and 5.94 cycles of bevacizumab, respectively. 20 had baseline anti-platelet/anticoagulant use, and 16 had prior VTEs. Patients with macrobleeds on MRI had a larger HR of developing acute hemorrhage [HR=2.368 (1.112, 5.043), p=0.0254]. Patients older than 50 trended toward larger HR of developing VTE in univariate analysis that approached significance [HR=1.799 (0.889, 3.637), p=0.1023]. Sex, performance status, IDH, MGMT, vascular risk factors, baseline anticoagulant/anti-platelet use and concurrent chemotherapy were not significantly associated with occurrence of VTE. CONCLUSIONS The presence of macrobleeds on MRI is associated with increased risk of developing acute ICH while on bevacizumab. Older age at diagnosis of HGG may be associated with an increased risk of VTE in patients receiving bevacizumab. Larger studies are needed to confirm these findings.

scholarly journals Vascular Events, Vascular Disease and Vascular Risk Factors—Strongly Intertwined with COVID-19

2020 ◽  
Vol 22 (11) ◽  
Author(s):  
Adrian Scutelnic ◽  
Mirjam R. Heldner
Keyword(s):  
Risk Factors ◽  
Vascular Disease ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Vascular Events ◽  
Increased Risk ◽  
Clinical Benefits ◽  
Infection And Inflammation ◽  
Unhealthy Diet ◽  
New Perspective

Abstract Purpose of review To elucidate the intertwining of vascular events, vascular disease and vascular risk factors and COVID-19. Recent findings Strokes are a leading cause of disability and death worldwide. Vascular risk factors are important drivers of strokes. There are unmodifiable vascular risk factors such as age and ethnicity and modifiable vascular risk factors. According to the INTERSTROKE study, the 10 most frequent modifiable vascular risk factors are arterial hypertension, physical inactivity, overweight, dyslipidaemia, smoking, unhealthy diet, cardiac pathologies, diabetes mellitus, stress/depression and overconsumption of alcohol. Also, infection and inflammation have been shown to increase the risk of stroke. There is high-quality evidence for the clinical benefits of optimal primary and secondary stroke prevention. The COVID-19 pandemic brought a new perspective to this field. Vascular events, vascular disease and vascular risk factors—and COVID-19—are strongly intertwined. An increased risk of vascular events—by multifactorial mechanisms—has been observed in COVID-19 patients. Also, a higher rate of infection with COVID-19, severe COVID-19 and bad outcome has been demonstrated in patients with pre-existing vascular disease and vascular risk factors. Summary At present, we suggest that regular interactions between healthcare professionals and patients should include education on COVID-19 and on primary and secondary vascular prevention in order to reduce the burden of disease in our ageing populations.

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