Prognosis of cervical artery dissection

Abstract

The prognosis of cervical artery dissection (CAD) patients mainly depends on the severity of the initial stroke and the risk of subsequent stroke. The overall functional prognosis of patients with stroke due to CAD does not differ from that of young patients with stroke due to other causes. The annual risk of recurrent stroke ranges from 0.3 to 3.4%. Early recurrences are often in the territory of the CAD when arterial lesions had not completely recovered. Conversely, long-term recurrent ischemic events seem to take place in all territories and can be due to various mechanisms. The prognosis of CAD patients also depends on the arterial outcome. Stenotic lesions resolve within a few months, most often without visible sequel on angiogram, in about 70% of patients. Recanalization of occluded vessels is less frequent but in more recent studies, which used imaging to confirm the presence of a mural hematoma, recanalization occurred in up to 90% of cases. Carotid aneurysms persist in about two third of cases while vertebral aneurysms seem to frequently resolve. Complications related to persistent aneurysm seem to be exceptional. The overall risk of CAD recurrence is low, ranging from 0.3 to 1.4% but seems to be higher within the first month and some recurrences are asymptomatic. Patients with connective tissue disease or familial history of CAD have an increased risk of CAD recurrence, but other risk factors remain unknown.