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Meta-Analysis
. 2024 Apr;19(4):388-396.
doi: 10.1177/17474930231201434. Epub 2023 Sep 21.

Recurrence of cervical artery dissection: A systematic review and meta-analysis

Elizabeth Lounsbury  1   2 , Naomi Niznick  1   2 , Ranjeeta Mallick  3 , Brian Dewar  3 , Alexandra Davis  4 , Dean A Fergusson  1   3 , Dar Dowlatshahi  1   2   3 , Michel Shamy  1   2   3
Affiliations
Meta-Analysis

Recurrence of cervical artery dissection: A systematic review and meta-analysis

Elizabeth Lounsbury et al. Int J Stroke. 2024 Apr.

Abstract

Background and purpose: Cervical artery dissection (CAD) involving the carotid or vertebral arteries is an important cause of stroke in younger patients. The purpose of this systematic review is to assess the risk of recurrent CAD.

Methods: A systematic review and meta-analysis was conducted on studies in which patients experienced radiographically confirmed dissections involving an extracranial segment of the carotid or vertebral artery and in whom CAD recurrence rates were reported.

Results: Data were extracted from 29 eligible studies (n = 5898 patients). Analysis of outcomes was performed by pooling incidence rates with random effects models weighting by inverse of variance. The incidence of recurrent CAD was 4% overall (95% confidence interval (CI) = 3-7%), 2% at 1 month (95% CI = 1-5%), and 7% at 1 year in studies with sufficient follow-up (95% CI = 4-13%). The incidence of recurrence associated with ischemic events was 2% (95% CI = 1-3%).

Conclusions: We found low rates of recurrent CAD and even lower rates of recurrence associated with ischemia. Further patient-level data and clinical subgroup analyses would improve the ability to provide patient-level risk stratification.

Keywords: Dissection; ischemic stroke; outcome; recurrence.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Overall incidence of recurrent cervical artery dissection for each study and overall, presented with their confidence intervals and measure of heterogeneity.
Figure 2.
Figure 2.
Incidence rates for secondary outcome of recurrent cervical artery dissection at 1 month for each study and overall, presented with their confidence intervals and measure of heterogeneity.
Figure 3.
Figure 3.
Incidence rates for secondary outcome of recurrent cervical artery dissection at 1 year for each study with sufficient follow-up duration, and overall, presented with their confidence intervals and measure of heterogeneity.
Figure 4.
Figure 4.
Incidence of recurrent cervical artery dissection symptomatic of ischemia for each study in which this outcome was reported, and overall, presented with their confidence intervals and measure of heterogeneity.
Figure 5.
Figure 5.
Subgroup analysis of the primary outcome of overall incidence of recurrent cervical artery dissection in studies that did and did not include routine surveillance imaging as part of their follow-up protocol, presented with their confidence intervals and measures of heterogeneity.
Figure 6.
Figure 6.
Primary outcome of overall incidence of recurrent cervical artery dissection for the subgroup of high-quality studies only, presented with their confidence intervals and measure of heterogeneity.
See this image and copyright information in PMC

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