Recurrence of cervical artery dissection: protocol for a systematic review

Abstract

IntroductionCervical artery dissection, including carotid and vertebral artery dissection, is an important cause of stroke in the young. Risk of developing cervical artery dissection has been associated with physical activity in various forms and has been presumed to be related to minor trauma and mechanical stretching of the cervical arteries. This systematic review will aim to synthesise data on the risk of recurrent cervical artery dissection after an initial dissection. This information may be applied to further understand the natural history of this disease, and potentially to help direct evidence-based discussions on safe return to activity after dissection.Methods and analysisA broad search of multiple electronic databases (Medline, Embase, Cochrane Central Register of Controlled Trials and Web of Science) will be conducted to identify studies published as of 13 November 2019, examining all-comers with cervical artery dissection observed over time. Studies will be screened by two independent reviewers in a two-level process to determine eligibility for inclusion. Data will be pooled from eligible articles and the main outcome of recurrent cervical artery dissection at 5 years will be determined using quantitative analysis.Ethics and disseminationEthics approval is not necessary as no primary data are being collected. The information will be disseminated in the form of a systematic review article which will be submitted to a peer-reviewed medical journal.PROSPERO registration numberCRD42020166105.

Segmental Arterial Mediolysis: A Multiguised Vasospastic Arteriopathy with Collateral Mesangial Cell Hyperplasia and Cardiac Toxicity Generated by Norepinephrine and Hyperdense Adrenoceptors Alone or by Crosstalk with Other Pressor Agents

“…It is a leading cause of stroke in young and healthy individuals. VAD is associated with physical and sporting activates and chiropractor manipulations, events that could traumatize or physically stretch the vertebral artery causing intimal damage and tears and/or stimulate the adrenal to release catecholamines [27]. VAD, like SAM, presents with two different clinical profiles but these are anatomically determined-subarachnoid hemorrhages in the intracranial potion of the vertebral, posterior inferior cerebellar and basilar arteries, and ischemic lesions and infarcts developing in the cerebellum, brain stem, and upper spinal cord from stenosis or occlusion of the extracranial segment of this artery and/or its major branches.…”

Recurrence of cervical artery dissection: A systematic review and meta-analysis

“…International Journal of Stroke, 19 (4) all-comers is tangible for patients and is a helpful starting point in framing these discussions.…”

“…Empty cells represent insufficient data, either because it was not reported or because minimum follow-up duration was shorter than the specified time point.International Journal of Stroke, 19(4) …”

Treating inflammation to reduce stroke risk, non-motor symptoms after stroke, cerebral microinfarcts in cancer, and prognosis in cervical dissection

“…Lounsbury and colleagues extracted data from 29 studies including 5898 patients. 27 On meta-analysis, the incidence of recurrent cervical artery dissection was 4% overall, while the incidence of recurrence associated with ischemic events was 2%. The average follow-up period ranged from 3.9 to 93.6 months.…”