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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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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>N/A.</p><p><strong>Guarantor: </strong>Lukas Mayer-Suess.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 9","pages":"627"},"PeriodicalIF":4.6000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426123/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of spontaneous recanalization of occlusive cervical artery dissection on risk of stroke.\",\"authors\":\"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\",\"doi\":\"10.1007/s00415-025-13371-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Occlusive cervical artery dissection (CeAD) is associated with worse patient outcome. 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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.</p><p><strong>Conclusions: </strong>Spontaneous recanalization in occlusive CeAD is associated with lower rates of stroke upon follow-up. 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引用次数: 0
摘要
闭塞性颈动脉夹层（CeAD）与较差的患者预后相关。急性血运重建措施的净临床效益必须与自发再通的可能性进行权衡。我们的目的是评估迄今为止尚未解决的自发性再通对闭塞性脑卒中患者卒中风险的影响。方法：对队列研究中未接受急性血运重建措施的初始闭塞性头部血管病患者进行MRI验证。随访数据来源于临床常规和研究特定评估。关注的结果是发生(i)再通和（ii）缺血性脑卒中的头部相关闭塞上游。调整后的逻辑回归分析解决了再通对上述结果的影响。结果：328例患者中有97例（29.6%）存在闭塞性脑血管病，未接受急性血运重建治疗。在随访中，56/97（57.7%）的患者表现为初始闭塞的头部动脉自发再通。女性（OR 0.41[0.18, 0.97]; P = 0.043）和颈内动脉夹层（OR 0.33[0.14, 0.78]; P = 0.012）是唯一独立与再通相关的因素。在8.2（1.58,12.8）年的中位随访中，共有18/97（18.6%）患者在最初受脑血管影响的血管上游发生缺血性卒中。在调整混杂因素后，自发性再通与随访时较低的脑缺血率独立相关（OR 0.28[0.09, 0.90]; P = 0.032），最显著的是与抗血栓治疗类型无关。结论：闭塞性脑卒中患者自发性再通与随访时较低的卒中发生率相关。这些结果表明，持续的头部相关闭塞仍然是复发性缺血性事件的危险因素，因此需要未来的试验来寻找最佳的药物治疗方法。试验注册：无。担保人：卢卡斯·梅尔·苏斯。
Impact of spontaneous recanalization of occlusive cervical artery dissection on risk of stroke.
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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