Dissection of Cervical Arteries: Long-term Follow-Up Study of 130 Consecutive Cases

Cerebrovasc Dis. 2006;22(2-3):150-4. doi: 10.1159/000093244. Epub 2006 May 10.

Abstract

Background and purpose: We describe the natural history, functional prognosis and long-term recurrences of patients with dissection of cervical arteries (DCA) in a sequential observational study.

Methods: We describe 130 patients with angiographically-proven DCA admitted to the Neurology Institute in Mexico City (Mexico), and analyzed clinical and neuroimaging data, treatment and outcome. Treatment with either anticoagulation or aspirin was decided by the primary physician. Primary outcome measures were recurrence (stroke and death) and clinical outcome at 6 months. Follow-up studies were performed to determine recanalization.

Results: Mean age was 35.4 years; 4 patients died (3%) and 126 were followed for 3,906 person/years; 17 patients (13%) had a heralding ischemic cerebral event (6 strokes, 11 TIAS) about 8 days before the diagnosis of DCA. After diagnosis, recurrent ischemic stroke occurred in 6 patients (4.8%) within the 2 first weeks (1.5 persons/1,000 follow-up years). No significant differences were found between aspirin and anticoagulation. Recanalization was more frequent in vertebral dissections. Complete recanalization of vertebral dissections was associated with a favorable prognosis [OR 3.2 (95% CI 1.1-8.8; p = 0.02)].

Conclusions: In Mexico, DCA affects young adults and may present with a heralding stroke or TIA. We found rare, early ischemic recurrences. Vertebral territory dissections had better prognosis than carotid ones, particularly in patients with demonstrated complete recanalization.

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use*
  • Aspirin / therapeutic use
  • Brain Ischemia / etiology
  • Brain Ischemia / prevention & control*
  • Carotid Artery, Internal, Dissection / complications
  • Carotid Artery, Internal, Dissection / drug therapy*
  • Carotid Artery, Internal, Dissection / prevention & control
  • Female
  • Humans
  • Male
  • Mexico
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Prognosis
  • Registries*
  • Retrospective Studies
  • Secondary Prevention
  • Stroke / etiology
  • Stroke / prevention & control*
  • Treatment Outcome
  • Vertebral Artery Dissection / complications
  • Vertebral Artery Dissection / drug therapy*
  • Vertebral Artery Dissection / prevention & control

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors
  • Aspirin