Determinants and outcome of multiple and early recurrent cervical artery dissections

Compter, Annette; Schilling, Sabrina; Vaineau, Cloé; Goeggel-Simonetti, Barbara; Metso, Tiina M.; Southerland, Andrew M; Pezzini, Alessandro; Kloß, Manja; Touzé, Emmanuel; Worrall, Bradford B.; Thijs, Vincent; Béjot, Yannick; Reiner, Peggy; Grond‐Ginsbach, Caspar; Bersano, Anna; Brandt, Tobias; Caso, Valeria; Lyrer, Philippe; Traenka, Christopher; Lichy, Christoph; Martin, Juan J.; Leys, Didier; Sarıkaya, Hakan; Baumgartner, R. W.; Jung, Simon; Fischer, Urs; Engelter, Stefan T.; Dallongeville, Jean; Chabriat, Hugues; Tatlısumak, Turgut; Bousser, Marie‐Germaine; Arnold, Marcel; Debette, Stéphanie

doi:10.1212/wnl.0000000000006037

Cited by 37 publications

(48 citation statements)

References 41 publications

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“…Although multiple dissections were more often associated with risk factors or predisposing activities, the CADISP study showed no effect on 3-month functional outcome measured by modified Rankin Scale score. Results from a multicenter study evaluating multiple and early recurrent CeAD by the CADISP group in 2018 revealed no difference in functional outcomes but a higher incidence of cerebral ischemia at 3 to 6 months compared with single nonrecurrent CeAD patients [18]. The CADISP group also analyzed a subcohort of 690 CeAD and 556 non-CEAD ischemic stroke patients [19].…”

Section: Discussionmentioning

confidence: 99%

Early Anticoagulation or Antiplatelet Therapy Is Critical in Craniocervical Artery Dissection: Results from the COMPASS Registry

et al. 2020

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Introduction: Craniocervical artery dissection (CeAD) is a leading cause of stroke in the young patient population. Recent studies reported a low rate of major adverse cardiac events (MACEs) in patients with CeAD, with no significant difference between patients randomized to anticoagulation or antiplatelet therapy. Objective: To compare the effectiveness of anticoagulation and antiplatelet therapy in patients with CeAD. Methods: All CeAD patients from 2015 to 2017 were consecutively identified by an electronic medical record-based application and enrolled in this prospective longitudinal registry. CeAD was confirmed by imaging and graded using the Denver scale for blunt cerebrovascular injury. Patients were followed for 12 months for MACE defined as stroke, transient ischemic attack (TIA), or death. Results: The cohort included 111 CeAD patients (age 53 ± 15.9 years, 56% Caucasian, 50% female). CeAD was detected by magnetic resonance (5%), computed tomography (88%), or catheter angiography (7%). CeAD was noted in the carotid (59%), vertebral (39%), and basilar (2%) arteries, 82% of which were extracranial dissections. CeAD was classified as grade I, II, III, and IV in 16, 33, 19, and 32%, respectively. A total of 40% of dissections were due to known trauma. A predisposing factor was noted in the majority (78%) of patients, including violent sneezing (21%), carrying a heavy load (19%), sports/ recreational activity (11%), chiropractic manipulation (9%), abrupt/prolonged rotation of head (9%), and prolonged phone use (9%). At presentation, 41% had a stroke, 5% had TIA, 39% had headache, and 36% were asymptomatic. Favorable outcome defined as a modified Rankin Scale score of 0-2 was noted in 68% at 3 months and 71% at 12 months. The rate of MACEs at 3 and 12 months was 11 and 14%, respectively, with more events observed in patients who were not receiving anticoagulation/antiplatelet therapy due to contraindications (p = 0.008). Conclusions: We report diagnostic characteristics, as well as short-and long-term outcomes of CeAD. A high MACE rate was observed within the first 2 weeks of CeAD diagnosis, notably in patients not initiated on anticoagulation or antiplatelet therapy.

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Section: Discussionmentioning

confidence: 99%

Early Anticoagulation or Antiplatelet Therapy Is Critical in Craniocervical Artery Dissection: Results from the COMPASS Registry

et al. 2020

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“…56 Interestingly, MWA has been associated with atrial fibrillation and patent foramen ovale (PFO) -2 conditions associated with emboli. 61 There are a few published cases of cervical artery dissection in association with triptan use, but a causality link has not been demonstrated,the association may be with migraine and not with triptan use. 59,60 Migraine is not known to predispose to recurrence.…”

Section: Expert Commentarymentioning

confidence: 99%

“…59,60 Migraine is not known to predispose to recurrence. 61 There are a few published cases of cervical artery dissection in association with triptan use, but a causality link has not been demonstrated,the association may be with migraine and not with triptan use. 62 Returning to our theoretical patient in Case 2, we can assume that the stroke had an identifiable cause unrelated to triptan use and that using eletriptan is very unlikely to increase the risk of another stroke.…”

mentioning

confidence: 99%

Triptans for Migraine Patients With Vascular Risks: New Insights, New Options

Leroux

Rothrock

2019

Headache

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“…In most hospital-based series, 60%-80% of CeAD patients had stroke [4][5][6]. Most patients have a single CeAD during their life, but 10%-15% of the patients present with multiple dissections in different cervical arteries during the acute phase or with new dissection shortly after the first event [6,7], which suggests the existence of a transient vulnerable phase with increased risk of CeAD [8,9]. Although cohorts of patients with recurrent CeAD have been relatively small so far, few recurrent dissections were observed to cause stroke [8,9].…”

Section: Introductionmentioning

confidence: 99%

Recurrent versus first cervical artery dissection – a retrospective study of clinical and vascular characteristics

Kloß

Калашникова

Добрынина

et al. 2020

Euro J of Neurology

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Background and purpose: Most recurrent cervical artery dissection (CeAD) events occur shortly after the acute first CeAD. This study compared the characteristics of recurrent and first CeAD events and searched for associations between subsequent events of an individual person. Methods: Cervical artery dissection patients with a new CeAD event occurring during a 3-6 month follow-up were retrospectively selected in seven specialized stroke centers. Clinical and vascular characteristics of the initial and the recurrent CeADs were compared. Results: The study sample included 76 patients. Recurrent CeADs were occlusive in one (1.3%) patient, caused cerebral ischaemia in 13 (17.1%) and were asymptomatic in 39 (51.3%) patients, compared to 29 (38.2%) occlusive, 42 (55.3%) ischaemic and no asymptomatic first CeAD events. In 52 (68.4%) patients, recurrent dissections affected both internal carotid arteries or both vertebral arteries, whilst 24 (31.6%) patients had subsequent dissections in both types of artery. Twelve (28.6%) of 42 patients with an ischaemic first dissection had ischaemic symptoms due to the recurrent CeADs, too. However, only one (1.3%) of 34 patients with a non-ischaemic first CeAD suffered ischaemia upon recurrence. Conclusion: Recurrent CeAD typically affects the same site of artery. It causes ischaemic events less often than the first CeAD. The risk that patients who presented with solely non-ischaemic symptoms of a first CeAD will have ischaemic symptoms in the case of a recurrent CeAD seems very small.

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Determinants and outcome of multiple and early recurrent cervical artery dissections

Cited by 37 publications

References 41 publications

Early Anticoagulation or Antiplatelet Therapy Is Critical in Craniocervical Artery Dissection: Results from the COMPASS Registry

Early Anticoagulation or Antiplatelet Therapy Is Critical in Craniocervical Artery Dissection: Results from the COMPASS Registry

Triptans for Migraine Patients With Vascular Risks: New Insights, New Options

Recurrent versus first cervical artery dissection – a retrospective study of clinical and vascular characteristics

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