Journal article
Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection
Stroke (1970), Vol.56(6), pp.1413-1421
06/2025
DOI: 10.1161/STROKEAHA.124.048215
PMID: 40143807
Abstract
Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals.
This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022. The primary outcome was subsequent ischemic stroke by day 180 after diagnosis. Clinical and imaging variables were compared between those with versus without subsequent ischemic stroke. Significant factors associated with subsequent stroke risk were identified using stepwise Cox regression. Associations between subsequent ischemic stroke risk and antithrombotic therapy type (anticoagulation versus antiplatelets) among patients with identified risk factors were explored using adjusted Cox regression.
In all, 4023 patients (mean age was 47.4 years; 44.5% were women) were included. By day 180, subsequent ischemic stroke occurred in 5.3% of the cohort. In adjusted Cox regression, factors associated with increased risk of subsequent ischemic stroke were prior history of ischemic stroke (adjusted hazard ratio [aHR], 7.31 [95% CI, 1.61-33.13];
=0.010), presentation within 7 days from first symptoms (aHR, 3.04 [95% CI, 1.04-8.91];
=0.043), infarct on baseline imaging (aHR, 9.85 [95% CI, 3.65-26.58];
<0.001), and occlusive dissection (aHR, 2.34 [95% CI, 1.03-5.34];
=0.043). Only patients with occlusive dissection demonstrated a reduced risk of subsequent ischemic stroke when treated with anticoagulation versus antiplatelets (aHR, 0.36 [95% CI, 0.16-0.80];
=0.01).
In this post hoc analysis of the STOP-CAD study, several factors associated with subsequent ischemic stroke were identified among patients with CAD. Furthermore, we identified a potential benefit of anticoagulation in patients with CAD with occlusive dissection. These findings require validation by meta-analyses of prior studies to formulate optimal treatment strategies for specific high-risk CAD subgroups.
Details
- Title: Subtitle
- Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection
- Creators
- Daniel M Mandel - Brown UniversityLiqi Shu - Brown UniversityChristopher Chang - Brown UniversityNaomi Jack - Brown UniversityChristopher R Leon Guerrero - Department of Neurology, Atrium Health, Charlotte, NC (C.R.L.G.)Nils Henninger - University of Massachusetts Chan Medical SchoolJayachandra Muppa - University of Massachusetts Chan Medical SchoolMuhammad Affan - University of MinnesotaOmair Ul Haq Lodhi - University of MinnesotaMirjam R Heldner - University Hospital of BernKateryna Antonenko - University of BernDavid Seiffge - University of BernMarcel Arnold - University of BernSetareh Salehi Omran - University of Colorado Anschutz Medical CampusRoss Crandall - University of Colorado DenverEvan Lester - University of Colorado DenverDiego Lopez Mena - Instituto Nacional de Neurología y NeurocirugíaAntonio Arauz - Instituto Nacional de Neurología y NeurocirugíaAhmad Nehme - Normandie UniversitéMarion Boulanger - Normandie UniversitéEmmanuel Touze - Normandie UniversitéJoao Andre Sousa - University of CoimbraJoao Sargento-Freitas - University of CoimbraVasco Barata - University of CoimbraPaulo Castro-Chaves - Hospital de São JoãoMaria Teresa Brito - Hospital de São JoãoMuhib Khan - Corewell HealthDania Mallick - Corewell HealthAaron Rothstein - University of PennsylvaniaOssama Khazaal - University of PennsylvaniaJosefin E Kaufman - University Hospital of BaselStefan T Engelter - Felix Platter-HospitalChristopher Traenka - Felix Platter-HospitalDiana Aguiar de Sousa - University of LisbonMafalda Soares - Centro Hospitalar de Lisboa CentralSara Rosa - Centro Hospitalar de Lisboa CentralLily W Zhou - University of British ColumbiaPreet Gandhi - University of British ColumbiaThalia S Field - University of British ColumbiaIssa Metanis - Hadassah Medical CenterSteven Mancini - University of British ColumbiaRonen R Leker - Hadassah Medical CenterKelly Pan - Brown UniversityVishnu Dantu - Brown UniversityKarl Baumgartner - Brown UniversityTina Burton - Brown UniversityRegina von Rennenberg - Charité - Universitätsmedizin BerlinChristian H Nolte - Charité - Universitätsmedizin BerlinRichard Choi - Department of Neurosciences, ChristianaCare, Newark, DE (R. Choi, J.M.)Jason MacDonald - Christiana Care Health SystemReza Bavarsad Shahripour - University of California San DiegoXiaofan Guo - Loma Linda UniversityMalik Ghannam - University of IowaMohammad Almajali - University of IowaEdgar A Samaniego - University of IowaSebastian Sanchez - University of IowaBastien Rioux - Université de MontréalFaycal Zine-Eddine - Université de MontréalAlexandre Poppe - Université de MontréalAna Catarina Fonseca - University of LisbonMaria Fortuna Baptista - Hospital de Santa MariaDiana Cruz - University of LisbonMichele Romoli - Ospedale “M. Bufalini” di CesenaGiovanna De Marco - Ospedale “M. Bufalini” di CesenaMarco Longoni - Ospedale “M. Bufalini” di CesenaZafer Keser - Mayo Clinic in ArizonaKim Griffin - Mayo Clinic in ArizonaLindsey Kuohn - Hinge HealthJennifer Frontera - Hinge HealthJordan Amar - Washington University in St. LouisJames Giles - Washington University in St. LouisMarialuisa Zedde - Azienda Sanitaria Unità Locale di Reggio EmiliaRosario Pascarella - Azienda Sanitaria Unità Locale di Reggio EmiliaIlaria Grisendi - Azienda Sanitaria Unità Locale di Reggio EmiliaHipolito Nzwalo - Algarve Biomedical CenterDavid S Liebeskind - University of California, Los AngelesAmir Molaie - University of California, Los AngelesAnnie Cavalier - Duke UniversityWayneho Kam - Rex HospitalBrian Mac Grory - Duke UniversitySami Al Kasab - Medical University of South CarolinaMohammad Anadani - Medical University of South CarolinaKimberly Kicielinski - Medical University of South CarolinaAli Eltatawy - University of Cincinnati Medical CenterLina Chervak - University of Cincinnati Medical CenterRoberto Chulluncuy Rivas - University of Cincinnati Medical CenterYasmin Aziz - University of CincinnatiEkaterina Bakradze - University of Alabama at BirminghamThanh Lam Tran - University of Alabama at BirminghamMarc Rodrigo Gisbert - Department of Neurology, University Hospital Vall d'Hebron, Barcelona, Spain (M.R.G., M. Requena)Manuel Requena - Vall d'Hebron Hospital UniversitariFaddi Saleh Velez - University of OklahomaJorge Ortiz Gracia - University of OklahomaVarsha Muddasani - Einstein Healthcare NetworkAdam de Havenon - Yale New Haven HospitalVenugopalan Y Vishnu - All India Institute of Medical SciencesSridhara Yaddanapudi - Thomas Jefferson UniversityLatasha Adams - Thomas Jefferson UniversityAbigail Browngoehl - Thomas Jefferson UniversityTamra Ranasinghe - Wake Forest University
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.56(6), pp.1413-1421
- DOI
- 10.1161/STROKEAHA.124.048215
- PMID
- 40143807
- NLM abbreviation
- Stroke
- ISSN
- 1524-4628
- eISSN
- 1524-4628
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Language
- English
- Electronic publication date
- 03/27/2025
- Date published
- 06/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984802510102771
Metrics
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