Liqi Shu, Lukas Strelecky, Adam de Havenon, Thanh N Nguyen, Nils Henninger, Zafer Keser, Muhib Khan, James Ernest Siegler, Mary Penckofer, Setareh Salehi Omran, Thalia S Field, Lily Zhou, Han Xiao, Austin Jacobson, Eric D Goldstein, Christoph Stretz, Farhan Khan, Elizabeth Perelstein, Karen Furie, Shadi Yaghi
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We aimed to determine national trends in CeAD admissions and examine post-CeAD risk of ischemic stroke.</p><p><strong>Methods: </strong>We used the National Inpatient Sample (2005-2019), National Readmission Database (2015-2019), and State Inpatient Database for New York (2011-2017) and Florida (2011-2019). Adult patients with spontaneous CeAD were identified using <i>International Classification of Diseases, Ninth Revision, Clinical Modification</i> and <i>International Classification of Diseases, Tenth Revision, Clinical Modification</i> codes. Survey-weighted annual CeAD cases were combined with US census data to estimate annual incidence. National estimates were verified with state-level data, which allows for the removal of duplicate admissions for a single patient through a unique patient identifier. Joinpoint regression was used to quantify the average annual percent change (AAPC) of CeAD incidence. AIS readmission risk after CeAD without concurrent AIS was assessed with death as a competing risk using Fine and Gray competing risk methodology.</p><p><strong>Results: </strong>From 2005 to 2019, we identified 125,102 patients (46.09% female, mean age 51.4 years) with spontaneous CeAD. CeAD incidence increased from 10.7 cases per million population in 2005 to 45.6 cases per million population in 2019, revealing an AAPC of 10.21% (95% CI 9.67%-10.76%). This substantial increase in CeAD admissions was particularly high in the older, Black, and Hispanic populations. Statewide data corroborated this upward trend with an AAPC of 8.47% (95% CI 7.97%-9.48%). Among patients with CeAD without AIS, vertebral artery dissection was the sole major predictor of subsequent ischemic stroke risk within 90 days (adjusted subdistributed hazard ratio 1.77, 95% CI 1.18-2.64, <i>p</i> = 0.006). Interaction and subgroup analyses were performed and demonstrated similar results.</p><p><strong>Discussion: </strong>There was an almost 5-fold increase in CeAD hospitalizations and an upward incidence trend from 2005 to 2019, particularly in racial minorities, which may be attributed to increased imaging and awareness of CeAD. Our study also revealed a small but significant risk of AIS in patients with vertebral artery dissection without concurrent ischemic stroke. These findings underscore the importance of studying acute treatment and secondary prevention strategies in patients with CeAD.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 9","pages":"e213548"},"PeriodicalIF":7.7000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966527/pdf/","citationCount":"0","resultStr":"{\"title\":\"Incidence Trends and Risk of Recurrent Stroke of Cervical Artery Dissections in the United States Between 2005 and 2019.\",\"authors\":\"Liqi Shu, Lukas Strelecky, Adam de Havenon, Thanh N Nguyen, Nils Henninger, Zafer Keser, Muhib Khan, James Ernest Siegler, Mary Penckofer, Setareh Salehi Omran, Thalia S Field, Lily Zhou, Han Xiao, Austin Jacobson, Eric D Goldstein, Christoph Stretz, Farhan Khan, Elizabeth Perelstein, Karen Furie, Shadi Yaghi\",\"doi\":\"10.1212/WNL.0000000000213548\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Cervical artery dissection (CeAD) is a common cause of acute ischemic stroke (AIS), especially in patients younger than 55 years, but data regarding trends and subsequent AIS risk after CeAD remain scarce. We aimed to determine national trends in CeAD admissions and examine post-CeAD risk of ischemic stroke.</p><p><strong>Methods: </strong>We used the National Inpatient Sample (2005-2019), National Readmission Database (2015-2019), and State Inpatient Database for New York (2011-2017) and Florida (2011-2019). Adult patients with spontaneous CeAD were identified using <i>International Classification of Diseases, Ninth Revision, Clinical Modification</i> and <i>International Classification of Diseases, Tenth Revision, Clinical Modification</i> codes. Survey-weighted annual CeAD cases were combined with US census data to estimate annual incidence. National estimates were verified with state-level data, which allows for the removal of duplicate admissions for a single patient through a unique patient identifier. Joinpoint regression was used to quantify the average annual percent change (AAPC) of CeAD incidence. AIS readmission risk after CeAD without concurrent AIS was assessed with death as a competing risk using Fine and Gray competing risk methodology.</p><p><strong>Results: </strong>From 2005 to 2019, we identified 125,102 patients (46.09% female, mean age 51.4 years) with spontaneous CeAD. CeAD incidence increased from 10.7 cases per million population in 2005 to 45.6 cases per million population in 2019, revealing an AAPC of 10.21% (95% CI 9.67%-10.76%). This substantial increase in CeAD admissions was particularly high in the older, Black, and Hispanic populations. Statewide data corroborated this upward trend with an AAPC of 8.47% (95% CI 7.97%-9.48%). Among patients with CeAD without AIS, vertebral artery dissection was the sole major predictor of subsequent ischemic stroke risk within 90 days (adjusted subdistributed hazard ratio 1.77, 95% CI 1.18-2.64, <i>p</i> = 0.006). 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引用次数: 0
摘要
背景和目的:颈动脉夹层(CeAD)是急性缺血性卒中(AIS)的常见原因,尤其是55岁以下的患者,但关于CeAD后的趋势和随后的AIS风险的数据仍然很少。我们的目的是确定全国脑卒中住院率的趋势,并检查脑卒中后缺血性卒中的风险。方法:我们使用了全国住院患者样本(2005-2019)、国家再入院数据库(2015-2019)和纽约州住院患者数据库(2011-2017)和佛罗里达州住院患者数据库(2011-2019)。采用《国际疾病分类》第九版《临床修改》和《国际疾病分类》第十版《临床修改》编码对自发性CeAD成年患者进行鉴定。调查加权的年度CeAD病例与美国人口普查数据相结合,以估计年发病率。通过州一级的数据验证了国家估计,这允许通过唯一的患者标识符删除单个患者的重复入院。采用连接点回归量化CeAD发病率的年均百分比变化(AAPC)。采用Fine和Gray竞争风险方法评估无并发AIS的CeAD后AIS再入院风险,并将死亡作为竞争风险。结果:从2005年到2019年,我们确定了125,102例自发性CeAD患者(46.09%为女性,平均年龄51.4岁)。CeAD发病率从2005年的每百万人10.7例增加到2019年的每百万人45.6例,AAPC为10.21% (95% CI 9.67%-10.76%)。在老年人、黑人和西班牙裔人群中,CeAD入学率的大幅增长尤为明显。全州范围内的数据证实了这一上升趋势,AAPC为8.47% (95% CI 7.97%-9.48%)。在没有AIS的CeAD患者中,椎动脉夹层是90天内缺血性卒中风险的唯一主要预测因素(校正亚分布风险比1.77,95% CI 1.18-2.64, p = 0.006)。进行了相互作用和亚组分析,并证明了相似的结果。讨论:从2005年到2019年,CeAD住院人数增加了近5倍,发病率呈上升趋势,特别是在少数民族中,这可能归因于对CeAD的成像和认识的提高。我们的研究还显示,椎动脉夹层无并发缺血性脑卒中的患者发生AIS的风险虽小但显著。这些发现强调了研究CeAD患者的急性治疗和二级预防策略的重要性。
Incidence Trends and Risk of Recurrent Stroke of Cervical Artery Dissections in the United States Between 2005 and 2019.
Background and objectives: Cervical artery dissection (CeAD) is a common cause of acute ischemic stroke (AIS), especially in patients younger than 55 years, but data regarding trends and subsequent AIS risk after CeAD remain scarce. We aimed to determine national trends in CeAD admissions and examine post-CeAD risk of ischemic stroke.
Methods: We used the National Inpatient Sample (2005-2019), National Readmission Database (2015-2019), and State Inpatient Database for New York (2011-2017) and Florida (2011-2019). Adult patients with spontaneous CeAD were identified using International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification codes. Survey-weighted annual CeAD cases were combined with US census data to estimate annual incidence. National estimates were verified with state-level data, which allows for the removal of duplicate admissions for a single patient through a unique patient identifier. Joinpoint regression was used to quantify the average annual percent change (AAPC) of CeAD incidence. AIS readmission risk after CeAD without concurrent AIS was assessed with death as a competing risk using Fine and Gray competing risk methodology.
Results: From 2005 to 2019, we identified 125,102 patients (46.09% female, mean age 51.4 years) with spontaneous CeAD. CeAD incidence increased from 10.7 cases per million population in 2005 to 45.6 cases per million population in 2019, revealing an AAPC of 10.21% (95% CI 9.67%-10.76%). This substantial increase in CeAD admissions was particularly high in the older, Black, and Hispanic populations. Statewide data corroborated this upward trend with an AAPC of 8.47% (95% CI 7.97%-9.48%). Among patients with CeAD without AIS, vertebral artery dissection was the sole major predictor of subsequent ischemic stroke risk within 90 days (adjusted subdistributed hazard ratio 1.77, 95% CI 1.18-2.64, p = 0.006). Interaction and subgroup analyses were performed and demonstrated similar results.
Discussion: There was an almost 5-fold increase in CeAD hospitalizations and an upward incidence trend from 2005 to 2019, particularly in racial minorities, which may be attributed to increased imaging and awareness of CeAD. Our study also revealed a small but significant risk of AIS in patients with vertebral artery dissection without concurrent ischemic stroke. These findings underscore the importance of studying acute treatment and secondary prevention strategies in patients with CeAD.
期刊介绍:
Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology.
As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content.
Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.