Recurrent versus first cervical artery dissection – a retrospective study of clinical and vascular characteristics

Abstract

Background and purpose: Most recurrent cervical artery dissection (CeAD) events occur shortly after the acute first CeAD. This study compared the characteristics of recurrent and first CeAD events and searched for associations between subsequent events of an individual person. Methods: Cervical artery dissection patients with a new CeAD event occurring during a 3-6 month follow-up were retrospectively selected in seven specialized stroke centers. Clinical and vascular characteristics of the initial and the recurrent CeADs were compared. Results: The study sample included 76 patients. Recurrent CeADs were occlusive in one (1.3%) patient, caused cerebral ischaemia in 13 (17.1%) and were asymptomatic in 39 (51.3%) patients, compared to 29 (38.2%) occlusive, 42 (55.3%) ischaemic and no asymptomatic first CeAD events. In 52 (68.4%) patients, recurrent dissections affected both internal carotid arteries or both vertebral arteries, whilst 24 (31.6%) patients had subsequent dissections in both types of artery. Twelve (28.6%) of 42 patients with an ischaemic first dissection had ischaemic symptoms due to the recurrent CeADs, too. However, only one (1.3%) of 34 patients with a non-ischaemic first CeAD suffered ischaemia upon recurrence. Conclusion: Recurrent CeAD typically affects the same site of artery. It causes ischaemic events less often than the first CeAD. The risk that patients who presented with solely non-ischaemic symptoms of a first CeAD will have ischaemic symptoms in the case of a recurrent CeAD seems very small.

Cervical Artery Dissection and Sports

“…In absence of clear evidence, this question requires-in our opinion-an individual decision taking into account the circumstances of the occurrences of the CeAD in the individual patient (particularly in relation to sports), the meaning of sports for the individual well-being, the presence or absence of comorbidities or of neurological sequela, neurovascular findings, and whether there are signs of an underlying connective tissue alteration. Further, recurrence of CeAD is infrequent, and clusters within the first weeks to 3 months after the index CeAD (47,48) and strokes attributable to CeAD do occur (or reoccur) with a preference for the first 2 weeks after diagnosis (49). Serial ultrasound examinations in CeAD patients identified the occurrence of new arterial findings, of which several were associated with clinical symptoms in particular in the first 4 weeks.…”

Advances in Management of the Stroke Etiology One-Percenters

“…One of the most common causes of ischemic stroke in the young is carotid and vertebral artery dissection [ 1 – 4 ], conjunctly termed cervical artery dissection. Patients can present with headache or neck pain in the majority of cases, as well as with focal neurologic deficits, potentially referrable to either involvement damage sympathetic fibers or involvement of the brain parenchyma secondary to ischemia.…”

“…Regardless of treatment agents and modality, follow-up imaging is generally obtained in the outpatient setting, preferably using a similar modality to that obtained at the time of diagnoses. Recurrence rate of repeat dissection can be significant; although the majority of patients will not have any further dissections on follow-up, one series found a recurrence risk of up to 16.4% in over 2 years [ 1 ], generally in the same affected artery [ 1 , 15 ].…”