Determinants and outcome of multiple and early recurrent cervical artery dissections

Author:

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

Abstract

ObjectiveTo assess putative risk factors and outcome of multiple and early recurrent cervical artery dissection (CeAD).MethodsWe combined data from 2 multicenter cohorts and compared patients with multiple CeAD at initial diagnosis, early recurrent CeAD within 3 to 6 months, and single nonrecurrent CeAD. Putative risk factors, clinical characteristics, functional outcome, and risk of recurrent ischemic events were assessed.ResultsOf 1,958 patients with CeAD (mean ± SD age 44.3 ± 10 years, 43.9% women), 1,588 (81.1%) had single nonrecurrent CeAD, 340 (17.4%) had multiple CeAD, and 30 (1.5%) presented with single CeAD at admission and had early recurrent CeAD. Patients with multiple or early recurrent CeAD did not significantly differ with respect to putative risk factors, clinical presentation, and outcome. In multivariable analyses, patients with multiple or early recurrent CeAD more often had recent infection (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.29–2.53), vertebral artery dissection (OR 1.82, 95% CI 1.34–2.46), family history of stroke (OR 1.55, 95% CI 1.06–2.25), cervical pain (OR 1.36, 95% CI 1.01–1.84), and subarachnoid hemorrhage (OR 2.85, 95% CI 1.01–8.04) at initial presentation compared to patients with single nonrecurrent CeAD. Patients with multiple or early recurrent CeAD also had a higher incidence of cerebral ischemia (hazard ratio 2.77, 95% CI 1.49–5.14) at 3 to 6 months but no difference in functional outcome compared to patients with single nonrecurrent CeAD.ConclusionPatients with multiple and early recurrent CeAD share similar risk factors, clinical characteristics, and functional outcome. Compared to patients with single nonrecurrent CeAD, they are more likely to have recurrent cerebral ischemia at 3 to 6 months, possibly reflecting an underlying transient vasculopathy.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical)

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