Stenting as a treatment for <scp>cranio‐cervical</scp> artery dissection: Improved major adverse cardiovascular event‐free survival

Vezzetti, Alexandra; Rosati, Lauren M.; Lowe, Forrest; Graham, Cole Blease; Moftakhar, Roham; Mangubat, Erwin Zeta; Sen, Souvik

doi:10.1002/ccd.29890

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…Therefore, fast recognition of CeAD-related clinical symptoms (such as trivial trauma, headaches, or neck pain shortly before the event) and imaging to demonstrate the intramural hematoma, followed by immediate antithrombotic treatment, is vital . Future studies should focus on determining optimal treatment, with regard to both antithrombotic treatment and endovascular therapy with stent placement in a selected group of patients who are at high-risk …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…25 Future studies should focus on determining optimal treatment, with regard to both antithrombotic treatment and endovascular therapy with stent placement in a selected group of patients who are at high-risk. 26 When the TOAST classification 27 was developed, certain stroke causes could not yet be identified and were classified cryptogenic, whereas other, rarer causes were classified into 1 category.…”

Section: Jama Network Open | Neurologymentioning

confidence: 99%

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Short-Term and Long-Term Risk of Recurrent Vascular Event by Cause After Ischemic Stroke in Young Adults

Verburgt,

Hilkens,

Ekker

et al. 2024

JAMA Netw Open

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ImportanceCause of ischemic stroke in young people is highly variable; however, the risk of recurrence is often presented with all subtypes of stroke grouped together in classification systems such as the Trial of ORG (danaparoid sodium [Orgaran]) 10172 in Acute Stroke Treatment (TOAST) criteria, which limits the ability to individually inform young patients with stroke about their risk of recurrence.ObjectiveTo determine the short-term and long-term risk of recurrent vascular events after ischemic stroke at a young age by stroke cause and to identify factors associated with recurrence.Design, Setting, and ParticipantsThis cohort study used data from the Observational Dutch Young Symptomatic Stroke Study, a prospective, multicenter, hospital-based cohort study, conducted at 17 hospitals in the Netherlands between 2013 and 2021. Eligible participants included 30-day survivors of an initial, neuroimaging-proven ischemic stroke (aged 18-49 years). Data analysis was conducted from June to July 2023.ExposureDiagnosis of a first-ever, ischemic stroke via neuroimaging.Main Outcome and MeasuresThe primary outcome was short-term (within 6 months) and long-term (within 5 years) recurrence risk of any vascular event, defined as fatal or nonfatal recurrent ischemic stroke, transient ischemic attack, myocardial infarction, and revascularization procedure. Predefined characteristics were chosen to identify factors associated with risk of recurrence (cause of stroke, age, sex, stroke severity, and cardiovascular health factors).ResultsA total of 1216 patients (median [IQR] age, 44.2 [38.4-47.7] years; 632 male [52.0%]; 584 female [48.0%]) were included, with a median (IQR) follow-up of 4.3 (2.6-6.0) years. The 6-month risk of any recurrent ischemic event was 6.7% (95% CI, 5.3%-8.1%), and the 5-year risk was 12.2% (95% CI, 10.2%-14.2%)The short-term risk was highest for patients with cervical artery dissections (13.2%; 95% CI, 7.6%-18.7%). Other factors associated with a recurrent short-term event were atherothrombotic stroke, rare causes of stroke, and hypertension. The long-term cumulative risk was highest for patients with atherothrombotic stroke (22.7%; 95% CI, 10.6%-34.7%) and lowest for patients with cryptogenic stroke (5.8%; 95% CI, 3.0%-8.5%). Cardioembolic stroke was associated with a recurrent long-term event, as were diabetes and alcohol abuse.Conclusions and RelevanceThe findings of this cohort study of 1216 patients with an ischemic stroke at a young age suggest that the risk of recurrent vascular events was high and varied by cause of stroke both for short-term and long-term follow-up, including causes that remained concealed when combined into 1 category in the routinely used TOAST criteria. This knowledge will allow for more personalized counseling of young patients with stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Neurologymentioning

confidence: 99%

See 1 more Smart Citation

Short-Term and Long-Term Risk of Recurrent Vascular Event by Cause After Ischemic Stroke in Young Adults

Verburgt,

Hilkens,

Ekker

et al. 2024

JAMA Netw Open

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“…A single high-volume center study showed that stenting was beneficial to patients, particularly with the development of high-grade stenosis or expanding pseudoaneurysm. [ 20 ] Another study showed that surgical reconstruction could prevent chronic carotid dissection from ischemic or thromboembolic complications if 6 months of anticoagulation treatment failed or progression of dissection occurred. [ 21 ] In patients presenting with symptomatic CAD with acute IS within 4.5 hours of onset, alteplase should be used for intravenous thrombolysis if available and not contraindicated.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of one traumatic carotid artery dissection: A case report and review of the literature

Jia,

Zhu

2024

Medicine

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Rationale: Dissection of the cervical arteries is the most commonly identified cause of stroke in young patients. This report helps to investigate the etiology, diagnosis, and treatment of cervical artery dissection (CAD). Patient concerns: A 40-year-old female presented with a 3-week history of right carotid artery dissection due to a fall. The patient was admitted to the local hospital 3 weeks ago with a right neck impingement after a fall, and presented with right neck pain. The local hospital CT scan showed a dissection of the middle segment of the right common carotid artery. Diagnoses: The patient clinical manifestations and imaging tests confirmed that right carotid artery dissection. Interventions: Medical treatment with antiplatelet failed, and the CT scan showed progression of dissection. Carotid endarterectomy (CEA) was performed, and the prognosis is good. Outcomes: This patient was followed up at 1 and 6 months after the operation, CT scan showed the original stenotic vessels returned to standard diameter. Lessons: Diagnosis of CAD mainly depends on clinical manifestations and imaging. we recommend that clinicians can prescribe either anticoagulants or antiplatelet therapy. CAD can be effectively treated by surgical reconstruction, if medical treatment with anticoagulation or antiplatelet fails or if carotid aneurysms and/or high-grade carotid stenosis persisted or have newly developed.

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“…According to literature data, therapeutic management of CAD includes the antithrombotic regimen (anticoagulation, signal antiplatelet and dual antiplatelet) [1,[16][17][18] and endovascular intervention (carotid artery stent implantation) [19,20]. The annual recurrent acute stroke rates range from 0.3 to 3.4% and that of transient ischemic attack (TIA) from 0.6 to 1.7% [21].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Bilateral Internal Carotid Arteries Dissection with Acute Stroke - A Case for Stent Implantation and Antithrombotic Therapy and literature review

Wang

Cai

et al. 2023

Preprint

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Background Internal Carotid Arteries Dissection (ICAD) is a rare but important cause of severe acute ischemic stroke. Patients with ICAD are mostly treated with the antithrombotic regimen (anticoagulation, signal antiplatelet and dual antiplatelet), or endovascular treatment. The recurrence rate of carotid artery dissection stroke is relatively low. Here, we present a case of middle-aged male patient with acute ischemic strokes was caused by spontaneous bilateral ICAD. Stent placement in combine with antiplatelet therapy is a beneficial treatment method for such patient, as a preferred option. Case presentation: We present a case of a 54 -year-old male with no history of arteriopathy who presented with left limber weakness and slurred speech. Cerebral magnetic resonance imaging (MRI) showed acute large area cerebral infarcts in the right hemisphere. Digital subtraction angiography (DSA) demonstrated that the right internal carotid artery (ICA) occlusion at the cervical portion. He was found to have dissections in the right intracranial carotid arteries. He was treated with dual antiplatelet therapy and right carotid artery stent implantation. However, the patient still developed new neurological deficits, after stenting and balloon dilatation in the right carotid artery and postoperative antiplatelet therapy. MRI showed that acute left cerebral hemisphere infarction. Cervical computed tomography angiography and DSA revealed status of right carotid artery stent implantation and left ICA occlusion. Similarly, stent was performed in his left carotid artery, and dual antiplatelet therapy still continued. He was seen in the clinic at 6 months with follow-up imaging revealing improvement in the dissections. Conclusion The preferred option for patients with ICAD is to receive medication. If the ischemic event still occurs, invasive treatment should be carried out. However, ischemic stroke events were treated effectively with stenting and postoperative antiplatelet therapy.

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Stenting as a treatment for cranio‐cervical artery dissection: Improved major adverse cardiovascular event‐free survival

Cited by 5 publications

References 23 publications

Short-Term and Long-Term Risk of Recurrent Vascular Event by Cause After Ischemic Stroke in Young Adults

Short-Term and Long-Term Risk of Recurrent Vascular Event by Cause After Ischemic Stroke in Young Adults

Surgical treatment of one traumatic carotid artery dissection: A case report and review of the literature

Spontaneous Bilateral Internal Carotid Arteries Dissection with Acute Stroke - A Case for Stent Implantation and Antithrombotic Therapy and literature review

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