A case–control study of the determinants for cervicocerebral artery dissection

Cheng, Wenchao; Wang, Yuhan; Lian, Yajun; Zhang, Jing; Zheng, Yanan; Hu, Yiying; Chen, Yuan; Wu, Shouyi; Huang, Zhi; Shi, Yinping

doi:10.1007/s00415-018-9096-0

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…Most of our findings, particularly on the relationship between traditional cardiovascular risk factors and sCeAD, are substantially in line with those of the only observational study conducted so far, including a large series of patients with sCeAD (which partly overlaps with the present one), a group of patients with non‐CeAD IS and a group of stroke‐free control subjects, 12 as well as with those of other smaller studies 3,13–15 . Overall, these results underscore a neutral or inverse association of classic pro‐atherosclerotic risk factors with disease risk in comparison with the 2 control groups, with the only notable exception of hypertension, which is confirmed in our analysis as a major susceptibility factor for sCeAD 3 .…”

Section: Discussionsupporting

confidence: 90%

Risk Profile of Patients with Spontaneous Cervical Artery Dissection

Zotto

Grassi

Zedde

et al. 2023

Annals of Neurology

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ObjectiveEpidemiological data to characterize the individual risk profile of patients with spontaneous cervical artery dissection (sCeAD) are rather inconsistent.Methods and ResultsIn the setting of the Italian Project on Stroke in Young Adults Cervical Artery Dissection (IPSYS CeAD), we compared the characteristics of 1,468 patients with sCeAD (mean age = 47.3 ± 11.3 years, men = 56.7%) prospectively recruited at 39 Italian centers with those of 2 control groups, composed of (1) patients whose ischemic stroke was caused by mechanisms other than dissection (non‐CeAD IS) selected from the prospective IPSYS registry and Brescia Stroke Registry and (2) stroke‐free individuals selected from the staff members of participating hospitals, matched 1:1:1 by sex, age, and race. Compared to stroke‐free subjects, patients with sCeAD were more likely to be hypertensive (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.37–1.98), to have personal history of migraine with aura (OR = 2.45, 95% CI = 1.74–3.34), without aura (OR = 2.67, 95% CI = 2.15–3.32), and family history of vascular disease in first‐degree relatives (OR = 1.69, 95% CI = 1.39–2.05), and less likely to be diabetic (OR = 0.65, 95% CI = 0.47–0.91), hypercholesterolemic (OR = 0.75, 95% CI = 0.62–0.91), and obese (OR = 0.41, 95% CI = 0.31–0.54). Migraine without aura was also associated with sCeAD (OR = 1.81, 95% CI = 1.47–2.22) in comparison with patients with non‐CeAD IS. In the subgroup of patients with migraine, patients with sCeAD had higher frequency of migraine attacks and were less likely to take anti‐migraine preventive medications, especially beta‐blockers, compared with the other groups.InterpretationThe risk of sCeAD is influenced by migraine, especially migraine without aura, more than by other factors, increases with increasing frequency of attacks, and seems to be reduced by migraine preventive medications, namely beta‐blockers. ANN NEUROL 2023

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Section: Discussionsupporting

confidence: 90%

Risk Profile of Patients with Spontaneous Cervical Artery Dissection

Zotto

Grassi

Zedde

et al. 2023

Annals of Neurology

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“…The methods had been established and described in detail previously [5]. Consecutive patients with cervicocerebral artery dissection treated in the Interventional Neurology Department of the First Affiliated Hospital of Zhengzhou University from 2010 to 2017 were prospectively registered as study subjects, who were categorized into patients with and without ischemic events.…”

Section: Study Populationmentioning

confidence: 99%

Predictors of Ischemic Events Secondary to Cervicocerebral Artery Dissection

Cheng

Wang

Lian

et al. 2019

Preprint

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Objective: To identify the predictors of ischemic events secondary to cervicocerebral artery dissection (CAD). Methods: Consecutive patients with cervicocerebral artery dissection from 2010 to 2017 were registered as study subjects, who were classified as patients with and without ischemic events. Clinical data were collected prospectively, such as demographics, vascular risk factors, headache and neck pain, dissection site and laboratory test. A case-control study was performed to compare the clinical data between two groups. Results: A total of 130 patients with cervicocerebral artery dissection were included, in which 70.0% (91/130) suffered from ischemic events, including 81 ischemic strokes and 10 transient ischemic attacks. There were 46.2% (42/91) and 25.6% (10/39) of the artery dissections located in the anterior circulation in the CAD patients with and without ischemic events respectively (p=0.029). The average level of HDL was (1.14±0.38) mmol/L in the CAD patients with ischemic events, and (1.28±0.48) mmol/L in the CAD patients without ischemic events (p=0.083). However, no significant differences were found in the other clinical data. Multivariate logistic regression analysis showed that there was a positive correlation between anterior circulation and ischemic events (OR=3.204, 95% CI 1.305-7.863, p=0.011) and HDL level was negatively correlated with ischemic events (OR=0.335, 95% CI 0.130-0.867, p=0.024) in CAD patients. Conclusion: Ischemic events are common complications of cerebrovascular disease in CAD patients, especially for those with an artery dissection located in the anterior circulation and low serum HDL level. Key Word: cervicocerebral artery dissection, ischemic event, HDL, anterior circulation, predictor

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“…CeAD remains uncommon, with an incidence reported to be approximately 3 per 100,000 for carotid artery dissection (CAD) and 1 per 100,000 for vertebral artery dissection (VAD) [ 3 ], accounting for approximately 2% of all ischemic strokes [ 4 , 5 ]. In a recent case-control study of 165 patients with ischemic strokes, age < 50 years old, headache, and neck pain positively correlated with a diagnosis of CeAD, and those symptoms were a common prodrome of CeAD [ 6 ]. Blunt or penetrating trauma can precede CeAD but the etiology of spontaneous CeAD is unclear [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Association between cervical artery dissection and spinal manipulative therapy –a medicare claims analysis

Whedon

Petersen

et al. 2022

BMC Geriatr

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Background Cervical artery dissection and subsequent ischemic stroke is the most serious safety concern associated with cervical spinal manipulation. Methods We evaluated the association between cervical spinal manipulation and cervical artery dissection among older Medicare beneficiaries in the United States. We employed case-control and case-crossover designs in the analysis of claims data for individuals aged 65+, continuously enrolled in Medicare Part A (covering hospitalizations) and Part B (covering outpatient encounters) for at least two consecutive years during 2007–2015. The primary exposure was cervical spinal manipulation; the secondary exposure was a clinical encounter for evaluation and management for neck pain or headache. We created a 3-level categorical variable, (1) any cervical spinal manipulation, 2) evaluation and management but no cervical spinal manipulation and (3) neither cervical spinal manipulation nor evaluation and management. The primary outcomes were occurrence of cervical artery dissection, either (1) vertebral artery dissection or (2) carotid artery dissection. The cases had a new primary diagnosis on at least one inpatient hospital claim or primary/secondary diagnosis for outpatient claims on at least two separate days. Cases were compared to 3 different control groups: (1) matched population controls having at least one claim in the same year as the case; (2) ischemic stroke controls without cervical artery dissection; and (3) case-crossover analysis comparing cases to themselves in the time period 6–7 months prior to their cervical artery dissection. We made each comparison across three different time frames: up to (1) 7 days; (2) 14 days; and (3) 30 days prior to index event. Results The odds of cervical spinal manipulation versus evaluation and management did not significantly differ between vertebral artery dissection cases and any of the control groups at any of the timepoints (ORs 0.84 to 1.88; p > 0.05). Results for carotid artery dissection cases were similar. Conclusion Among Medicare beneficiaries aged 65 and older who received cervical spinal manipulation, the risk of cervical artery dissection is no greater than that among control groups.

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A case–control study of the determinants for cervicocerebral artery dissection

Cited by 5 publications

References 20 publications

Risk Profile of Patients with Spontaneous Cervical Artery Dissection

Risk Profile of Patients with Spontaneous Cervical Artery Dissection

Predictors of Ischemic Events Secondary to Cervicocerebral Artery Dissection

Association between cervical artery dissection and spinal manipulative therapy –a medicare claims analysis

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