Journal article
Recurrent Cervical Artery Dissection Prevalence and Predictors: A Secondary Analysis of the STOP-CAD Study
Stroke (1970)
01/12/2026
DOI: 10.1161/STROKEAHA.125.053299
PMID: 41521918
Abstract
Patients with cervical artery dissection (CeAD) may experience a recurrent dissection, but its frequency, risk factors, and clinical implications are not well defined. We aimed to determine the risk, associated factors, and clinical impact of recurrent CeAD.
The STOP-CAD study was a multicenter international retrospective observational study of patients with CeAD treated between January 2015 and June 2022. Recurrent dissection was defined as a CeAD occurring at least 7 days after the diagnosis of the index event that affects a different artery or a different segment of the same artery. Patients were followed from day 7 up to 2 years. The absolute risk of recurrent CeAD over time was calculated using Kaplan-Meier survival estimates. Multivariable logistic and Cox regression models were used to assess predictors of CeAD recurrence.
Of the 4023 patients included in STOP-CAD, 3836 (median age 46 years, 45% females) were eligible for this analysis. During a median (interquartile range) follow-up of 295 (97-720) days, 88 (2.29%) patients had a CeAD recurrence. Median time-to-recurrent CeAD was 53 (interquartile range, 18-157) days. The estimated risk of recurrent CeAD at 2 years was 3.22% (95% CI, 2.59%-4.00%). In multivariable analyses, younger age (adjusted odds ratios, 0.98 [95% CI, 0.96-0.99]), migraine (adjusted odds ratio, 1.88 [95% CI, 1.14-3.07]), and fibromuscular dysplasia (adjusted odds ratio, 2.90 [95% CI, 1.66-5.06]) were associated with CeAD recurrence, while presenting with an ischemic stroke was associated with a lower likelihood of recurrence (adjusted odds ratio, 0.47 [95% CI, 0.29-0.75]). These associations with CeAD recurrence over time were confirmed by Cox regression analyses. Among the 88 patients with recurrent CeAD, only 5 had accompanying ischemic events (3 strokes, 2 transient ischemic attacks).
In this retrospective study, recurrent CeAD was uncommon, approximately half of the events were diagnosed within the first 2 months of the index event, and recurrent events rarely caused new ischemic events. Younger age, migraine, absence of ischemic stroke at presentation, and signs of fibromuscular dysplasia may help identify high-risk patients.
Details
- Title: Subtitle
- Recurrent Cervical Artery Dissection Prevalence and Predictors: A Secondary Analysis of the STOP-CAD Study
- Creators
- João Pedro Marto - University of LisbonLiqi Shu - Brown UniversityEileen Wu - Brown UniversityDaniel M Mendel - West Virginia UniversityMirjam R Heldner - University of BernJosefin E Kaufmann - University of BaselRonen R Leker - Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L., I.M.)Marialuisa Zedde - Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy (M.Z.)Ahmad Nehme - Charmo UniversityJayachandra Muppa - University of Massachusetts Chan Medical SchoolDiana Aguiar de Sousa - Faculdade de Medicina da Universidade de Lisboa, Portugal (D.A.d.S.)João André Sousa - Department of Neurology, Centro Hospitalar Universitário de Coimbra, Portugal (J.A.S.)Ana Catarina Fonseca - Hospital de Santa MariaHipólito Nzwalo - Department of Internal Medicine, Centro Hospital Universitario do Algarve, Faro, Portugal (H.N.)Michele Romoli - Department of Neurosciences, Bufalini Hospital, Cesena, Italy (M.R.)Setareh Salehi Omran - Department of Neurology, University of Colorado, Aurora (S.S.O., E.L., R.C.)Zafer Keser - Mayo ClinicReza Bavarsad Shahripour - Department of Neuroscience, University of California at San Diego (R.B.S.)Wayneho Kam - Comprehensive Stroke Center, University of North Carolina Health Rex, Raleigh (W.K.)Adeel Zubair - Yale New Haven HospitalFaddi G Saleh Velez - University of Oklahoma Health Sciences CenterCheran Elangovan - University of Tennessee at KnoxvilleBalaji Krishnaiah - University of Tennessee at KnoxvilleIssa Metanis - Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L., I.M.)Rosario Pascarella - Ospedale Santa MariaJames E Siegler - University of ChicagoAaron Rothstein - University of PennsylvaniaOssama Khazaal - University of PennsylvaniaKateryna Antonenko - University of BernAlexis N Simpkins - Cedars-Sinai Medical CenterEvan Lester - Department of Neurology, University of Colorado, Aurora (S.S.O., E.L., R.C.)Ross Crandall - Department of Neurology, University of Colorado, Aurora (S.S.O., E.L., R.C.)Sara Rosa - Unidade Local de Saúde de São JoséMafalda Delgado Soares - Unidade Local de Saúde de São JoséEkaterina Bakradze - University of Alabama at BirminghamJoshua Z Willey - Columbia University Irving Medical CenterMalik Ghannam - University of IowaEdgar A Samaniego - Department of Neurology, University of Iowa (M.G., E.A.S.)Marwa Elnazeir - University of LouisvillePiers Klein - Boston UniversityChristopher Traenka - University of BaselNils Henninger - University of Massachusetts Chan Medical SchoolThanh N Nguyen - Boston UniversityStefan T Engelter - University of BaselShadi Yaghi - Brown University
- Resource Type
- Journal article
- Publication Details
- Stroke (1970)
- DOI
- 10.1161/STROKEAHA.125.053299
- PMID
- 41521918
- NLM abbreviation
- Stroke
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Publisher
- American Heart Association
- Language
- English
- Electronic publication date
- 01/12/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9985121498902771
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