scholarly journals Combined Anticoagulation and Antiaggregation in Acute Cervical Artery Dissection

2021 ◽  
Vol 10 (19) ◽  
pp. 4580
Author(s):  
Philipp von von Gottberg ◽  
Victoria Hellstern ◽  
Christina Wendl ◽  
Marc E. Wolf ◽  
Ludwig Niehaus ◽  
...  
Keyword(s):  
Adverse Events ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Residual Stenosis ◽  
Stroke In Young Adults ◽  
Cervical Artery ◽  
Insignificant Difference ◽  
Major Adverse Events ◽  
Stroke In Young

Cervical artery dissection (CAD) is a frequent cause of stroke in young adults. Previous studies investigating the efficiency of anticoagulation (AC) versus antiplatelet therapy (AT) found an insignificant difference. We therefore retrospectively evaluated a combination of AC plus AT in patients with acute CAD regarding safety and efficacy. Twenty-eight patients with CAD and minor neurological symptoms/no major infarction received either single (n = 14) or dual AT (n = 14) combined with AC. Angiographic follow-up during hospitalization, 4-8 weeks and 3–6 months after CAD focused on occlusion, residual stenosis, and functional recanalization. Possible adverse events were surveyed. We compared the AC plus AT group to 22 patients with acute CAD treated with AC or AT. Compared to preceding AC-/AT-only studies, AC plus single or dual AT resulted in more frequent, faster recanalization. Frequency and severity of adverse events was comparable. No major adverse events or death occurred. Preceding works on conservative treatment of CAD are discussed and compared to this study. Considerations are given to pathophysiology and the dynamic of CAD. Combining AC plus AT in CAD may result in more reliable recanalization in a shorter time. The risk for adverse events appears similar to treatment with only AC or AT.

scholarly journals Diagnosis and outcome of cervical artery dissection

2011 ◽  
Vol 64 (7-8) ◽  
pp. 392-396 ◽  
Author(s):  
Ivana Divjak ◽  
Petar Slankamenac ◽  
Mirjana Jovicevic ◽  
Tamara Rabi-Zikic ◽  
Aleksandar Jesic
Keyword(s):  
Young Adults ◽  
Magnetic Resonance ◽  
Functional Outcome ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Long Term Outcome ◽  
Stroke In Young Adults ◽  
Malignant Infarction ◽  
Cervical Artery ◽  
Stroke In Young

Introduction. Spontaneous dissection of the cervical artery is a rare non-atherosclerotic vascular disease of unknown aetiology and unclear pathogenesis that may be a cause of ischemic stroke in young adults. Diagnosis. Precise diagnosis of dissection of the cervical artery - carotid or vertebral - is possible with cervical axial magnetic resonance imaging and magnetic resonance angiography. Treatment. The recommended treatment in the acute phase of cervical artery dissection is anticoagulant or antithrombotic therapy, aimed at preventing a primary or recurrent ischemic event. There have been as yet no results of randomized controlled studies comparing efficacy of both treatments. An ongoing randomized multicentre study is expected to provide answers about the effects of these treatments in cervical artery dissection. Outcome. Complete resolution of arterial abnormalities is achieved in around 46% of stenoses, 33% of occlusions, and 12% of dissecting aneurysms. Recurrent events. Recurrence of cerebral ischemia and cervical artery dissection seems to be rare, although some data suggest that early ischemic and late cervical artery dissection recurrences could be underestimated. Mortality and functional outcome. In comparison with other causes of stroke in young adults, the functional outcome of cervical artery dissection is good in contrast to its socio-professional effects, which may be unsatisfactory. The mortality rate of cervical artery dissection is low, although it may be underestimated since some patients with malignant infarction die before the diagnosis is established. Conclusion. Further research is warranted to improve our understanding of the underlying pathophysiology, to assess the long-term outcome, and ultimately to provide treatment and prevention strategies.

Migraine improvement after spontaneous cervical artery dissection the Italian Project on Stroke in Young Adults (IPSYS)

2018 ◽  
Vol 40 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Valeria De Giuli ◽  
◽  
Francesca Graziano ◽  
Andrea Zini ◽  
Marialuisa Zedde ◽  
...  
Keyword(s):  
Young Adults ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke In Young Adults ◽  
Cervical Artery ◽  
Stroke In Young

Ischemic Stroke in Young Adults Caused by Cervical Artery Dissection—A Retrospective Study

2021 ◽  
Author(s):  
Lucija Jazbec ◽  
Marija Menih ◽  
Rok Arh
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Retrospective Study ◽  
Arterial Hypertension ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke In Young Adults ◽  
Cervical Artery ◽  
Stroke In Young

Abstract Background Ischemic stroke is one of the most common causes of death and disability. The most common independent cause is cervical artery dissection, which represents around 20% of all cases of ischemic stroke in young adults. Risk factors for dissection include male gender, migraine (particularly with aura), hyperhomocysteinemia, recent infection, recent history of minor cervical trauma, young age, current smoking status, increased leucocyte count, and shortened activated partial thromboplastin time, whereas hypercholesterolemia and being overweight appear protective. Patients and Methods This retrospective study was based on data of all patients aged 18 to 49 who were hospitalized in the University Medical Centre Maribor for ischemic stroke between 2010 and 2019 inclusive. The results of the research were analyzed by IBM SPSS Statistics 28 software. For statistical significance, a cut-off value of p < 0.05 was used. Results The study includes 196 patients with 198 events of ischemic stroke. Dissection of cervical arteries was presented in 16 (8.2%) cases. The presence of arterial hypertension proved to have a relation with the presence of a dissection; patients with dissection are less likely to suffer from arterial hypertension. Duration of hospitalization in the group with dissection lasted significantly longer than in the group without dissection. Conclusions Dissection of cervical or intracranial artery is an important cause of ischemic stroke, especially in young adults. Therefore, it should be considered in young adults with presentation of stroke who lack traditional and modifiable risk factors.

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

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 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

scholarly journals Stroke in young adults

2018 ◽  
Vol 8 (6) ◽  
pp. 501-506 ◽  
Author(s):  
Nirav Bhatt ◽  
Amer M. Malik ◽  
Seemant Chaturvedi
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Management Strategies ◽  
Cryptogenic Stroke ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke In Young Adults ◽  
New Information ◽  
Traditional Risk Factors ◽  
Stroke In Young

Purpose of reviewThe incidence of stroke in young adults is increasing, mainly driven by an increasing incidence of ischemic stroke in this population. We provide new information that has been recently presented regarding the risk factor prevalence, some specific etiologic causes, and management strategies in ischemic stroke in this population.Recent findingsRecent studies indicate a rapid increase in traditional risk factors in young adults. New information regarding the management of patent foramen ovale in cryptogenic stroke and cervical artery dissection is available.SummaryStroke in young adults is a rapidly growing problem with deep public health implications. There are many areas in this field, which require further research.

Clinical Usefulness of Serial Duplex Ultrasound in Cervical Artery Dissection Patients

2020 ◽  
Vol 49 (2) ◽  
pp. 206-215 ◽  
Author(s):  
Christopher Traenka ◽  
Jonathan Streifler ◽  
Philippe Lyrer ◽  
Stefan T. Engelter
Keyword(s):  
Clinical Symptoms ◽  
Duplex Ultrasound ◽  
Clinical Usefulness ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Median Length ◽  
Cervical Artery ◽  
Stroke Center ◽  
Ischemic Events

Purpose: To study the clinical usefulness of serial color-coded duplex ultrasound (DUS) examinations in cervical artery dissection (CeAD) patients. Methods: Single-center, CeAD registry-based re-review of serial, routine DUS exams in consecutive CeAD patients treated at the Stroke Center Basel, Switzerland (2009–2015). Two experienced raters reassessed all DUS for the occurrence of new arterial findings during follow-up, that is. (i) recanalization of the dissected artery (if occluded at baseline), (ii) delayed occlusion of a patent dissected artery, and (iii) recurrent CeAD. We studied whether these new arterial findings were associated with clinical symptoms. Results: In 94 CeAD patients (n = 40 female [42.6%], median age 46 years [interquartile range (IQR) 36.2–53]), 506 DUS examinations were reviewed covering a median length of follow-up of 54.1 weeks (IQR 30.5–100.5). In total, 105 dissected arteries were detected, of which 27 (25.7%) were occluded. In 28/94 patients (29.8%), 31 new arterial findings were recorded, which were associated with clinical symptoms in 9/31 (30%) patients. Recanalization of occluded CeAD was observed in 22/27 (81.5%) arteries and occurred in 20/22 arteries within 3 months. In 4/22 patients (18.2%), recanalization was associated with clinical symptoms (ischemic events [n = 2], pure local symptoms [n = 2]). Delayed occlusions were observed in 4/78 (5.1%) dissected arteries patent at baseline. All were clinically asymptomatic and occurred within 14 days from baseline. Recurrent CeAD (all symptomatic) occurred in 5 previously non-dissected arteries. Conclusion: In CeAD patients, follow-up DUS identified new arterial findings, of which several were associated with clinical symptoms: we found that about 1 of 5 recanalizations were associated with clinical symptoms, of whom half were ischemic symptoms. Further, delayed occlusions occurred in patients with no or mild stenosis at baseline and were asymptomatic. This study emphasizes the potential importance of repeated DUS in CeAD particularly in the early phase of up to 4 weeks.

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