Prognosis of Cervical Artery Dissection

Touzé, Emmanuel; Jy, Gauvrit; Méder, Jean-François; Jl, Mas

doi:10.1159/000088157

Cited by 41 publications

(33 citation statements)

References 44 publications

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“…16 Despite the largely good outcomes, ICAD is a possible potential cause of malignant middle cerebral artery syndrome in young patients. 224 A case-control study from Bern and Zurich in Switzerland matched 46 ICAD cases with severe stenosis or occlusion at 1 year to 46 controls with only transient arterial stenosis or occlusion, arguing against persisting severe stenosis or occlusion as a risk factor for poor outcome. Stroke severity at the 3-month follow-up was not significantly different between groups.…”

mentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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mentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

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“…25 Differing eligibility criteria (inclusion of transient ischemic attack and nonischemic CAD symptoms) for the majority of these open series do, however, not allow for a one-to-one comparison with the current study and its less favorable outcome.…”

Section: Discussionmentioning

confidence: 95%

Intravenous Thrombolysis in Stroke Attributable to Cervical Artery Dissection

Engelter

Rutgers

Hatz

et al. 2009

Stroke

111

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Background and Purpose-Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Whether this is also true for cervical artery dissection (CAD) is addressed in this study. Methods-We used the Swiss IVT databank to compare outcome and complications of IVT-treated patients with CAD with IVT-treated patients with other etiologies (non-CAD patients). Main outcome and complication measures were favorable 3-month outcome, intracranial cerebral hemorrhage, and recurrent ischemic stroke. Modified Rankin Scale score Յ1 at 3 months was considered favorable. Results-Fifty-five (5.2%) of 1062 IVT-treated patients had CAD. Patients with CAD were younger (median age 50 versus 70 years) but had similar median National Institutes of Health Stroke Scale scores (14 versus 13) and time to treatment (152.5 versus 156 minutes) as non-CAD patients. In the CAD group, 36% (20 of 55) had a favorable 3-month outcome compared with 44% (447 of 1007) non-CAD patients (OR, 0.72; 95% CI, 0.41 to 1.26), which was less favorable after adjustment for age, gender, and National Institutes of Health Stroke Scale score (OR, 0.50; 95% CI, 0.27 to 0.95; Pϭ0.03). Intracranial cerebral hemorrhages (asymptomatic, symptomatic, fatal) were equally frequent in CAD (14% [7%, 7%, 2%]) and non-CAD patients (14% [9%, 5%, 2%]; Pϭ0.99). Recurrent ischemic stroke occurred in 1.8% of patients with CAD and in 3.7% of non-CAD-patients (Pϭ0.71). Conclusion-IVT-treated patients with CAD do not recover as well as IVT-treated non-CAD patients. However, intracranial bleedings and recurrent ischemic strokes were equally frequent in both groups. Key Words: carotid artery Ⅲ cervical artery dissection Ⅲ complications Ⅲ dissection Ⅲ outcome Ⅲ thrombolysis I ntravenous thrombolysis (IVT) for acute ischemic stroke using recombinant tissue plasminogen activator has been shown to be safe and efficacious. 1,2 Treatment response seems to be independent of the underlying stroke mechanism. 3 However, whether this observation includes patients with strokes attributable to cervical artery dissection (CAD) has not been studied. CAD is characterized by intramural accumulation of blood. Theoretically, IVT might promote and increase the intramural bleeding in CAD and cause progressive hemodynamic worsening and infarct growth. In patients with stroke with aortic dissection extending to the cervical arteries, IVT might be dangerous as it is in patients with IVT for myocardial infarction. 4 -6 According to recent pilot data, the outcome of 7 IVT-treated patients with CAD tended to be worse than that of 7 patients with CAD not treated with IVT. 7 In turn, patients with CAD have not been excluded from randomized, placebo-controlled trials 1,8,9 of IVT in stroke. Treatment guidelines 10 do not advise against IVT in such patients, but randomized, placebo-controlled trial-based data about IVT versus placebo in patients with CAD are not available. Only information of case series without control groups and small sample sizes (ie, 30, 11 11, 12 6, 13 a...

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“…The real prevalence of SCAD causing exclusively local symptoms is unknown because not all patients with such symptoms undergo diagnostic investigation 2 . Besides, as the warning symptoms can be missed or underdiagnosed, the absolute risk of ischemic complications beyond the onset of local manifestations is also unknown 30 . In ICA dissection, headache is often frontotemporal, Spontaneous cervical artery dissection Campos-herrera et al…”

Section: Clinical Featuresmentioning

confidence: 99%

“…however, the efficacy of this therapy has never been established, as well as its benefit in the prevention of long-term ischemic events after SCAD 30,45 . heparin is usually prescribed in the acute phase, followed by oral anticoagulants for a mean period of three months 1,2 .…”

Section: Treatmentmentioning

confidence: 99%

Spontaneous cervical artery dissection: an update on clinical and diagnostic aspects

Campos-Herrera

Scaff

Yamamoto

et al. 2008

Arq. Neuro-Psiquiatr.

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-Spontaneous cervical arterial dissection (SCAD) is a non-traumatic tear or disruption in the wall of the internal carotid arteries or the vertebral arteries. It accounts for about 25% of strokes in patients aged under 45 years. Awareness of its clinical features and advances in imaging over the last two decades have contributed to earlier identification of this condition. SCAD has become the commonest form of vascular lesion identified in the cervical carotid and vertebral arteries, second only to atherosclerosis. This review is an update on the epidemiology, vulnerable arterial segments, risk factors, clinical features, diagnosis, current treatment and prognosis of SCAD.Key worDS: dissection, carotid, vertebral artery, stroke, angiography. Dissecção espontânea da artéria cervical: atualização sobre aspectos clínicos e diagnósticosResumo -Dissecção arterial cervical espontânea (DACe) é uma laceração ou ruptura na parede de artérias cervicais responsáveis pela irrigação sanguínea cerebral: artérias carótidas internas e artérias vertebrais. É responsável por cerca de 25% dos acidentes vasculares cerebrais isquêmicos em pacientes abaixo de 45 anos de idade. Ao longo das duas últimas décadas, com a maior conscientização sobre suas manifestações clínicas e o avanço das técnicas de neuroimagem, a DACe tem sido diagnosticada mais precocemente, tornando-se o tipo de lesão vascular mais comumente identificado nas artérias cervicais, sendo superada apenas pelas lesões ateroscleróticas. esta revisão é uma atualização sobre a epidemiologia, segmentos arteriais mais vulneráveis, fatores de risco, manifestações clínicas, diagnóstico, tratamento e prognóstico da DACe.PAlAvrAS-ChAve: dissecção, artéria vertebral, acidente vascular cerebral, arteriografia.

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Prognosis of Cervical Artery Dissection

Cited by 41 publications

References 44 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Intravenous Thrombolysis in Stroke Attributable to Cervical Artery Dissection

Spontaneous cervical artery dissection: an update on clinical and diagnostic aspects

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