Abstract
Abstract DP059: Incidence and Clinical Characteristics of Cervical Artery Dissection Following Chiropractic Cervical Manipulation: A Sub-Analysis of the STOP-CAD Study
Stroke (1970), Vol.57(Suppl_1)
02/2026
DOI: 10.1161/str.57.suppl_1.DP059
Abstract
Background: Cervical artery dissection (CeAD) is an important cause of stroke in young adults. Some studies reported that nearly 100 million cervical chiropractic manipulations occur in the US annually. The relationship between chiropractic cervical manipulation and CeAD remains a matter of debate, with few large-scale studies examining incidence and clinical characteristics.
Methods: We analyzed patients in the multi-center STOP-CAD registry (n=4,023) to identify CeAD cases diagnosed after chiropractic cervical manipulation. Demographics and clinical features were compared between CeAD with vs. without antecedent chiropractic manipulation using chi-square tests and t-tests. We built a multivariable binary logistic regression model that included factors associated with preceding chiropractic manipulation in univariate analyses i.e. those with p<0.05.
Results: Of 4,023 CeAD cases, 228 (5.7%) were diagnosed with dissection after chiropractic cervical manipulation which is estimated to be a rare occurrence after all cervical chiropractic manipulations. In multivariable binary logistic regression, factors associated with prior cervical manipulation were younger age (OR per year 0.98 95% CI 0.97-0.99, p = 0.014), female sex (OR 1.64, 95% CI 1.21-2.23), absence of diabetes (OR 0.24, 95% CI 0.08-0.78), presence of neck pain (OR 2.80, 95% CI 2.08-3.77), and isolated vertebral dissection (OR 2.15, 95% CI 1.57-2.94). Recurrent ischemic stroke rates did not differ between the two groups.
Conclusions: Nearly 1 in 20 cases of dissection reported antecedent cervical manipulation. Given the high frequency of cervical chiropractic manipulations and very low rates of dissections diagnosed after chiropractic manipulations, the likely risk of dissection associated with chiropractic manipulations is very low. Dissections diagnosed after cervical manipulation have a distinct profile and were more likely in younger women presenting with neck pain and isolated vertebral artery involvement. Whether the occurrence dissection preceded the cervical manipulation or not remains unclear.
Details
- Title: Subtitle
- Abstract DP059: Incidence and Clinical Characteristics of Cervical Artery Dissection Following Chiropractic Cervical Manipulation: A Sub-Analysis of the STOP-CAD Study
- Creators
- Rozaleen Aleyadeh - Brown UniversityZedde Marialuisa - Azienda Sanitaria Unità Locale di Reggio EmiliaJoao Pedro Marto - Hospital de Egas MonizNils Henninger - UMass Memorial Medical CenterJamil Said - Aga Khan University NairobiJennifer Frontera - NYU Langone HealthRicha Sharma - Yale UniversityRonen Leker - Hadassah Medical CenterThais Leite Secchi - Hospital Moinhos de VentoFransisca Indraswari - Brown UniversityAbid Qureshi - University of Kansas Medical CenterLily Zhou - University of British ColumbiaAlexandre Poppe - Centre Hospitalier de l’Université de MontréalHipolito Nzwalo - Universidade do Algarve, Faro, PortugalVictor Carrasco Wall - Universiti of Alberta, Edmonton, Alberta, CanadaAna Fonseca - Hospital de Santa MariaPiers Klein - Boston UniversityDavid Liebeskind - UCLA HealthSheila Martins - Hospital de Clínicas de Porto AlegreMalik Ghannam - University of IowaVishnu Dantu - Barrow Neurological InstituteJorge Ortiz Garcia - University of OklahomaGiovanna De Marco - Universitat Oberta de CatalunyaEkaterina Bakradze - University of Alabama at BirminghamMary Penckofer - Mass General BrighamAnvesh Balabhadra - The University of Texas Health Science Center at HoustonSetareh Salehi Omran - University of Colorado DenverChristopher Chang - Brown UniversityChristopher Leon Guerrero - Wake Forest UniversityVarsha Muddasani - The University of Texas Health Science Center at HoustonRegina von Rennenberg - Charité - Universitätsmedizin BerlinXiaofan Guo - UPMC, Pittsburgh, Pennsylvania, United StatesCheran Elangovan - University of Tennessee Health Science CenterMohammad AlMajali - University of IowaFaddi Saleh Velez - University of OklahomaReza Bavarsad Shahripour - University of California San DiegoDaniel Mandel - University of BridgeportAdeel Zubair - Yale UniversityMarwa Elnazeir - University of LouisvilleBalaji Krishnaiah - University of Tennessee at KnoxvilleChristoph Stretz - Brown UniversityShadi Yaghi - Hackensack Meridian Health
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.57(Suppl_1)
- DOI
- 10.1161/str.57.suppl_1.DP059
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Publisher
- Lippincott Williams & Wilkins
- Language
- English
- Date published
- 02/2026
- Academic Unit
- Neurology
- Record Identifier
- 9985132081002771
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