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. 2023 Sep;94(3):585-595.
doi: 10.1002/ana.26717. Epub 2023 Jun 15.

Risk Profile of Patients with Spontaneous Cervical Artery Dissection

Elisabetta Del Zotto  1 , Mario Grassi  2 , Marialuisa Zedde  3 , Andrea Zini  4 , Anna Bersano  5 , Carlo Gandolfo  6 , Giorgio Silvestrelli  7 , Claudio Baracchini  8 , Paolo Cerrato  9 , Corrado Lodigiani  10 , Simona Marcheselli  11 , Maurizio Paciaroni  12 , Alessandra Spalloni  13 , Manuel Cappellari  14 , Massimo Del Sette  15 , Anna Cavallini  16 , Enrico Maria Lotti  17 , Maria Luisa Delodovici  18 , Mauro Gentile  4 , Mauro Magoni  19 , Marina Padroni  20 , Cristiano Azzini  20 , Maria Vittoria Calloni  21 , Elisa Giorli  22 , Massimiliano Braga  23 , Paolo La Spina  24 , Fabio Melis  25 , Rossana Tassi  26 , Valeria Terruso  27 , Rocco Salvatore Calabrò  28 , Valeria Piras  29 , Alessia Giossi  30 , Sandro Sanguigni  31 , Carla Zanferrari  32 , Marina Mannino  33 , Irene Colombo  34 , Carlo Dallocchio  35 , Patrizia Nencini  36 , Valeria Bignamini  37 , Alessandro Adami  38 , Rita Bella  39 , Rosario Pascarella  40 , Zafer Keser  41 , Alessandro Pezzini  42 ; Italian Project on Stroke in Young Adults-Cervical Artery Dissection, (IPSYS CeAD) Research Group
Affiliations

Risk Profile of Patients with Spontaneous Cervical Artery Dissection

Elisabetta Del Zotto et al. Ann Neurol. 2023 Sep.

Abstract

Objective: Epidemiological data to characterize the individual risk profile of patients with spontaneous cervical artery dissection (sCeAD) are rather inconsistent.

Methods and results: In the setting of the Italian Project on Stroke in Young Adults Cervical Artery Dissection (IPSYS CeAD), we compared the characteristics of 1,468 patients with sCeAD (mean age = 47.3 ± 11.3 years, men = 56.7%) prospectively recruited at 39 Italian centers with those of 2 control groups, composed of (1) patients whose ischemic stroke was caused by mechanisms other than dissection (non-CeAD IS) selected from the prospective IPSYS registry and Brescia Stroke Registry and (2) stroke-free individuals selected from the staff members of participating hospitals, matched 1:1:1 by sex, age, and race. Compared to stroke-free subjects, patients with sCeAD were more likely to be hypertensive (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.37-1.98), to have personal history of migraine with aura (OR = 2.45, 95% CI = 1.74-3.34), without aura (OR = 2.67, 95% CI = 2.15-3.32), and family history of vascular disease in first-degree relatives (OR = 1.69, 95% CI = 1.39-2.05), and less likely to be diabetic (OR = 0.65, 95% CI = 0.47-0.91), hypercholesterolemic (OR = 0.75, 95% CI = 0.62-0.91), and obese (OR = 0.41, 95% CI = 0.31-0.54). Migraine without aura was also associated with sCeAD (OR = 1.81, 95% CI = 1.47-2.22) in comparison with patients with non-CeAD IS. In the subgroup of patients with migraine, patients with sCeAD had higher frequency of migraine attacks and were less likely to take anti-migraine preventive medications, especially beta-blockers, compared with the other groups.

Interpretation: The risk of sCeAD is influenced by migraine, especially migraine without aura, more than by other factors, increases with increasing frequency of attacks, and seems to be reduced by migraine preventive medications, namely beta-blockers. ANN NEUROL 2023;94:585-595.

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References

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