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.

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.

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.

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

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.

Traumatic cervical artery dissection in head injury: The value of follow-up brain imaging

2010 ◽  
Vol 112 (8) ◽  
pp. 691-694 ◽  
Author(s):  
M.J.H. Aries ◽  
B.M. De Jong ◽  
M. Uyttenboogaart ◽  
J.G. Regtien ◽  
J. van der Naalt
Keyword(s):  
Head Injury ◽  
Brain Imaging ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery

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.

Natural History of Cervical Artery Fibromuscular Dysplasia and Associated Neurovascular Events

2018 ◽  
Vol 46 (1-2) ◽  
pp. 33-39 ◽  
Author(s):  
Daniella Kadian-Dodov ◽  
Judith Z. Goldfinger ◽  
Susan Gustavson ◽  
Jeffrey W. Olin
Keyword(s):  
Fibromuscular Dysplasia ◽  
Medical Center ◽  
Imaging Study ◽  
Duplex Ultrasound ◽  
Complete Information ◽  
The United States ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Cervical Artery

Background and Purpose: Fibromuscular dysplasia (FMD) is a non-atherosclerotic arteriopathy most often affecting the carotid and renal arteries. In the United States Registry for FMD, 41.7% of patients experienced an aneurysm and/or dissection by the time of entry into the Registry. We sought to determine the occurrence of neurovascular events after FMD diagnosis and any changes on cervical artery imaging that may be attributable to FMD. Methods: Patients followed at the Mount Sinai Medical Center (US Registry for FMD enrollment center) with confirmed FMD and > 1 cervical artery imaging study (at least ± 6 months from the baseline carotid duplex ultrasound [CDU]) between the years 2003 and 2015 were included. Medical records and cervical artery imaging ([CDU], magnetic resonance angiogram [MRA], and computed tomography angiogram [CTA]) were reviewed. New arterial dissection, aneurysm, transient ischemic attack, stroke, or new FMD findings were recorded. Results: Among 146 FMD patients with complete information, 52 (35.6%) had an aneurysm and 52 (35.6%) had a dissection. Mean clinical follow-up was 35.3 ± 25.3 months (range 5–153 months); patients underwent 4 ± 2.7 CDU (range 1–17); 86.3% had ≥1 neck MRA or CTA. After FMD diagnosis, 3 patients (2%) experienced a new carotid artery dissection; 1 patient experienced a stroke due to concomitant atherosclerosis. No new aneurysms occurred. In patients with cervical artery FMD, imaging findings remained stable throughout follow-up. No patient developed new cervical artery FMD findings on follow-up imaging. Conclusions: No new cervical artery FMD or aneurysm was observed on subsequent imaging. New carotid dissection was uncommon over a mean follow-up period of 35.3 ± 25.3 months and was the only non-atherosclerotic vascular event observed after FMD diagnosis.

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