Cervical Artery Dissection in Young Women: Risk of Recurrence During Subsequent Pregnancies

2021 ◽  
pp. 10.1212/CPJ.0000000000001092
Author(s):  
Myriam Assif ◽  
Catherine Lamy ◽  
Solène De Gaalon ◽  
Yolande Caroit ◽  
Romain Bourcier ◽  
...  
Keyword(s):  
Medical Information ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Risk Of Recurrence ◽  
Vaginal Deliveries ◽  
Cervical Artery ◽  
History Of ◽  
Future Pregnancy ◽  
Type Of Delivery

AbstractObjectives:To assess the risk of recurrence of cervical artery dissection (CAD) during pregnancy and puerperium in women with a history of CAD, and then help physicians with providing medical information to women who wish to become pregnant.Methods:Women aged 16- 45 years who were admitted to our center for a CAD between 2005 and 2017 were identified from the hospital database and those with spontaneous and symptomatic CAD were included. They were then contacted to answer a questionnaire that was specifically designed in regard to the recurrence of CAD and pregnancies after the primary CAD.Results:91 patients satisfied our inclusion criteria and 89 were included in the analysis. During a median follow-up of 7.0 years, four women (4,4%) had recurrent CAD, although none during pregnancy or puerperium. Eighteen women (20%) had a total of 20 full-term pregnancies, occurring at least 6 months post-CAD. Of these 20 pregnancies, 13 (65%) were vaginal deliveries and 7 (35%) were cesarean sections. The reason for the absence of pregnancies after the initial CAD was unrelated to the vascular event in 89% of cases but 8% of the women had been advised by a physician to avoid any future pregnancy or they had been recommended to undergo an abortion or sterilization.Conclusion:In this study, there were no CAD recurrences during subsequent pregnancies or postpartum, irrespective of the type of delivery. Thus, pregnancy after a history of CAD appears to be safe.

scholarly journals Prognosis of carotid dissecting aneurysms

Neurology ◽  
2017 ◽  
Vol 88 (7) ◽  
pp. 646-652 ◽  
Author(s):  
Susanna C. Larsson ◽  
Alice King ◽  
Jeremy Madigan ◽  
Christopher Levi ◽  
John W. Norris ◽  
...  
Keyword(s):  
Natural History ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Anticoagulation Therapy ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery ◽  
History Of ◽  
Age And Sex

Objective:To determine the natural history of dissecting aneurysm (DA) and whether DA is associated with an increased recurrent stroke risk and whether type of antithrombotic drugs (antiplatelets vs anticoagulants) modifies the persistence or development of DA.Methods:We included 264 patients with extracranial cervical artery dissection (CAD) from the Cervical Artery Dissection in Stroke Study (CADISS), a multicenter prospective study that compared antiplatelet with anticoagulation therapy. Logistic regression was used to estimate age- and sex-adjusted odds ratios. We conducted a systematic review of published studies assessing the natural history of DA and stroke risk in patients with non-surgically-treated extracranial CAD with DA.Results:In CADISS, DA was present in 24 of 264 patients at baseline. In 36 of 248 patients with follow-up neuroimaging at 3 months, 12 of the 24 baseline DAs persisted, and 24 new DA had developed. There was no association between treatment allocation (antiplatelets vs anticoagulants) and whether DA at baseline persisted at follow-up or whether new DA developed. During 12 months of follow-up, stroke occurred in 1 of 48 patients with DA and in 7 of 216 patients without DA (age- and sex-adjusted odds ratio 0.84; 95% confidence interval 0.10–7.31; p = 0.88). Published studies, mainly retrospective, showed a similarly low risk of stroke and no evidence of an increased stroke rate in patients with DA.Conclusions:The results of CADISS provide evidence suggesting that DAs may have benign prognosis and therefore medical treatment should be considered.

Follow-Up of Patients with History of Cervical Artery Dissection

1995 ◽  
Vol 5 (1) ◽  
pp. 43-49 ◽  
Author(s):  
D. Leys ◽  
Th. Moulin ◽  
T. Stojkovic ◽  
S. Begey ◽  
D. Chavot
Keyword(s):  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery ◽  
History Of

Abstract TP220: Differential Risk Factors and Outcomes of Ischemic Stroke Due to Cervical Artery

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Aayushi Garg ◽  
Vaelan Molian ◽  
Kaustubh Limaye ◽  
David Hasan ◽  
Enrique C Leira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Confounding Variables ◽  
Cervical Artery ◽  
History Of ◽  
Neck Manipulation

Introduction: Cervical artery dissection (CeAD) is a major cause of acute ischemic stroke (AIS) in young adults. Its pathophysiology is distinct from the other etiologies of AIS and is determined by both genetic and environmental factors. In this study, we sought to determine the risk factors for and outcomes of AIS due to CeAD in young adults, in the era of increasing utilization of neuroimaging and neuro-intervention procedures. Methods: We retrospectively reviewed all cases of AIS between 15-45 years of age admitted to our comprehensive stroke center between January 2010 - November 2016. Risk factors and outcomes were compared between patients with and without CeAD using univariate analysis. Multivariable generalized linear and logistic regression models were used to adjust for confounding variables. Results: Of the total 333 patients with AIS included in the study (mean±SD age: 36.4±7.1 years; females 50.8%), CeAD was identified in 84 (25.2%) patients. When compared to the non-CeAD group, patients with CeAD were younger in age and more likely to have a history of migraine and recent chiropractic neck manipulation (p<0.05). Risk factors including hypertension, diabetes, hyperlipidemia and obesity were more prevalent in the non-CeAD group (p<0.05). Patients with CeAD had shorter hospital stay by an average of 1.8 days (95% CI=0.3-3.4, p<0.05), however, this difference was not statistically significant after adjustment for initial NIHSS score, age, gender, and comorbidities. Patients with CeAD were more likely to have worse functional outcome at discharge, defined as modified Rankin scale score (mRS) ≥3, independent of the above confounding variables (adjusted odds ratio 3.6, 95% CI=1.6-8.1). The in-hospital mortality rate, discharge disposition, mRS score and recurrence rates at follow-up (mean time 4.2 months) were similar between the two groups. Conclusions: While history of migraine and recent chiropractic neck manipulation are significantly associated with CeAD; most of the traditional vascular risk factors are less prevalent in this group. In comparison with AIS due to other etiologies, patients with CeAD have worse functional outcomes at the time of discharge but similar outcomes at follow up, which suggests a propensity for better recovery.

Young Male with Bilateral ICA Dissection: Beyond CADISS Trial

2021 ◽  
pp. 251660852098428
Author(s):  
Vikas Bhatia ◽  
Chirag Jain ◽  
Sucharita Ray ◽  
jay Kumar
Keyword(s):  
Management Strategies ◽  
Young Male ◽  
Acute Onset ◽  
The Body ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke Study ◽  
History Of

Objective: To report a case of young male with stroke and bilateral internal carotid artery (ICA) dissection. Background: Cervical Artery Dissection in Stroke Study trial has provided some insight on management of patients with ICA dissection. However, there is a need to modify the management strategies as per specific clinical scenario. Design/Methods: Case report and literature review. Results: A 45-year-old male presented with 1 month old history of acute onset numbness of right half of the body with slurring of speech. Computed tomography angiography showed complete occlusion of left cervical ICA just beyond origin with presence of fusiform dilatation and spiral flap in right extracranial cervical ICA. The patient was started on antiplatelets and taken for endovascular procedure using 2-mesh-based carotid stents. Patient was discharged after 3 days on antiplatelet therapy. At 1-year follow-up, there were no fresh symptoms. Conclusion: This case emphasizes the role of successful endovascular management of carotid dissection in a young male. These clinical situations may not be fully represented in trials, and a case-based approach is required.

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 W P223: Treatment of Cervical Artery Dissection with Different Antithrombotic Agents

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Fan Z Caprio ◽  
Deborah Bergman ◽  
Yvonne Curran ◽  
Richard Bernstein ◽  
Shyam Prabhakaran
Keyword(s):  
Recurrent Stroke ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Novel Oral Anticoagulants ◽  
Bleeding Complications ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery ◽  
Hemorrhagic Complications

Background and Purpose: Antiplatelet agents and anticoagulants are both accepted and commonly used agents for treatment of cervical artery dissection (CAD), though randomized clinical trials are lacking. We report on the use of novel oral anticoagulants for CAD and compared their efficacy and safety to traditional anticoagulants. Methods: We retrospectively identified patients diagnosed with CAD at a single academic center between July 2010 and December 2012. Patients treated with novel anticoagulants (NOAC: dabigatran or rivaroxaban), other anticoagulants (AC: warfarin, heparin, or low molecular weight heparin), or antiplatelet agents (AP: aspirin, clopidogrel, or aspirin-dypyridamole) were compared for baseline characteristics, recurrent stroke, vessel recanalization on follow-up, and bleeding complications using Fisher’s exact and student t-tests. Results: During the study period, 110 patients with CAD were included, of whom 20 (18%), 61 (55%), and 29 (26%) were treated initially with a NOAC, AC, and AP, respectively. Clinical follow-up was available in 98 (89.1%) patients while radiographic follow-up was available in 88 (80%) patients. NOAC-treated patients were more likely to have presented with ischemic stroke symptoms (90% vs. 55.7%, p=0.007) but had similar rates of severe stenosis (60% vs. 53.3%, p=0.522) and intraluminal/intramural thrombus (70% vs. 57.6%, p=0.327) on initial vascular imaging compared to AC patients. There was 1 recurrent stroke in the NOAC group and 1 in the AC group. Similar proportions of patients had resolved or improved stenosis on follow-up imaging (NOAC: 66.7 vs. AC: 63.3%, p=0.217). Hemorrhagic complications were more likely to occur in AC compared to NOAC patients (17.0% vs. 0%, p=0.019). Conclusion: In this retrospective study, use of novel oral anticoagulants for CAD was associated with similar rates of recurrent stroke and vessel recanalization on follow-up imaging but with fewer hemorrhagic complications. Given their safety profile, NOACs may be a reasonable alternative to traditional anticoagulants in CAD. Prospective validation of these findings is needed.

Recurrence of cervical artery dissection

Neurology ◽  
2018 ◽  
Vol 90 (16) ◽  
pp. e1372-e1378 ◽  
Author(s):  
Manja Kloss ◽  
Caspar Grond-Ginsbach ◽  
Peter Ringleb ◽  
Ingrid Hausser ◽  
Werner Hacke ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Recurrent Events ◽  
Clinical Symptoms ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Consecutive Series ◽  
Initial Event ◽  
Cervical Artery ◽  
Tissue Abnormalities

ObjectiveTo explore the recurrence of cervical artery dissection (CeAD).MethodsA single-center consecutive series of 282 CeAD patients was prospectively recruited during first admission from 1995 to 2012. Patients with a follow-up of at least 1 year (n = 238) were eligible for the current analysis. All patients with clinical symptoms or signs of recurrent CeAD on ultrasound were examined by MRI. Dermal connective tissue morphology was studied in 108 (45.4%) patients.ResultsMedian follow-up was 52 months (range 12–204 months). In all, 221 (92.8%) patients presented with monophasic CeAD, including 188 (79.0%) patients with a single CeAD event, 11 (4.6%) with simultaneous dissections in multiple cervical arteries, and 22 (9.2%) with subsequent events within a single phase of 4 weeks. Seventeen patients (7.1%) had late (>1 month after the initial event) recurrent CeAD events, including 5 (2.1%) with multiple recurrences. Patients with late recurrences were younger (37.5 ± 6.9 years) than those without (43.8 ± 9.9; p = 0.011). Ischemic stroke occurred in 164 (68.9%) patients at first diagnosis, but only 4 of 46 (8.7%) subsequent events caused stroke (p < 0.0001), while 19 (41.3%) were asymptomatic. Connective tissue abnormalities were found in 54 (56.3%) patients with monophasic and 8 (66.7%) with late recurrent dissections (p = 0.494).ConclusionTwenty-two (9.2%) patients had new CeAD events within 1 month and 17 (7.1%) later recurrences. The risk for new events was significantly higher (about 60-fold) during the acute phase than during later follow-up. Connective tissue abnormalities were not more frequent in patients with late recurrent events than in those with monophasic CeAD.

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 3854: Family History Of Cervical Artery Dissection In A Large Multicenter Cohort: The CADISP Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Stephanie Debette ◽  
Juan Jose Martin ◽  
Manja Kloss ◽  
Stefan Engelter ◽  
Tiina Metso ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Family History ◽  
Disease Incidence ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Degree Relative ◽  
Ehlers Danlos Syndrome ◽  
Multicenter Cohort ◽  
Cervical Artery ◽  
History Of

Background: Little data is available on familial occurrence of cervical artery dissection (CEAD), a major cause of ischemic stroke in young adults. We aimed to examine the prevalence of family history of CEAD in a large multicenter cohort of CEAD patients and compare characteristics of CEAD patients with and without such a family history. Methods: Across 18 neurological departments in 8 countries, consecutive patients with a diagnosis of CEAD were included in the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) cohort study following a standardized protocol and using the same questionnaire. Results: Among 921 consecutive CEAD patients, 11 patients (1.2%, 95%CI:0.5-1.9%) from 9 families (1.0%, 0.3-1.6%) had a family history of CEAD, mostly in a first degree relative (64%). One patient without family history of CEAD had biologically confirmed vascular Ehlers-Danlos syndrome, while none of the patients with a family history of CEAD had a diagnosis of known inherited connective tissue disorder. Risk factors, baseline features, and 3-month outcome did not differ significantly between CEAD patients with and without a family history of CEAD. Conclusion: In the largest series of CEAD patients to date, family history of CEAD was very rare, although slightly higher than expected by chance given the low disease incidence.

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