Lukas Mayer-Suess, Josefin E Kaufmann, Lukas Scherer, Anel Karisik, Malik Galijasevic, Stephanie Mangesius, Elke Ruth Gizewski, Stefan Kiechl, Christopher Traenka, Stefan T Engelter, Michael Knoflach
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引用次数: 0
Abstract
Introduction: Occlusive cervical artery dissection (CeAD) is associated with worse patient outcome. The net clinical benefit of acute revascularization measures has to be weighed against the likelihood of spontaneous recanalization. Our aim was to assess the hitherto un-addressed impact of spontaneous recanalization on stroke risk in patients with occlusive CeAD.
Methods: MRI verified CeAD patients with initially occlusive CeAD within cohort study that did not undergo acute revascularization measures were assessed. Follow-up data derived from clinical routine and study specific assessments. Outcomes of interest were occurrence of (i) recanalization and (ii) ischemic stroke upstream of CeAD-related occlusion. Adjusted logistic regression analysis addressed the impact of recanalization on said outcomes.
Results: 97/328 (29.6%) patients had occlusive CeAD and did not undergo acute revascularization treatment. Upon follow-up, 56/97 (57.7%) showed spontaneous recanalization of initially occlusive CeAD. Female sex (OR 0.41[0.18, 0.97]; P = 0.043) and internal carotid artery dissection (OR 0.33[0.14, 0.78]; P = 0.012) were the only factors independently associated with recanalization. Within a median follow-up of 8.2 (1.58, 12.8) years, a total of 18/97 (18.6%) patients suffered ischemic stroke upstream of the initially CeAD-affected vessel. After adjusting for confounders, spontaneous recanalization was independently associated with lower rates of cerebral ischemia upon follow-up (OR 0.28[0.09, 0.90]; P = 0.032), most notably also independent of type of antithrombotic treatment.
Conclusions: Spontaneous recanalization in occlusive CeAD is associated with lower rates of stroke upon follow-up. These results indicate that persistent CeAD-related occlusion remains a risk-factor for recurrent ischemic events, thus calling for future trials addressing optimal medical treatment.
期刊介绍：
The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field.
In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials.
Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.
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