Observational Study

. 2024 Apr;55(4):908-918.

doi: 10.1161/STROKEAHA.123.045731. Epub 2024 Feb 9.

Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study

Shadi Yaghi¹, Liqi Shu¹, Daniel Mandel¹, Christopher R Leon Guerrero², Nils Henninger³, Jayachandra Muppa³, Muhammad Affan⁴, Omair Ul Haq Lodhi⁴, Mirjam R Heldner⁵, Kateryna Antonenko⁵, David Seiffge⁵, Marcel Arnold⁵, Setareh Salehi Omran⁶, Ross Crandall⁶, Evan Lester⁷, Diego Lopez Mena⁸, Antonio Arauz⁸, Ahmad Nehme⁹, Marion Boulanger⁹, Emmanuel Touze⁹, Joao Andre Sousa¹⁰, Joao Sargento-Freitas¹⁰, Vasco Barata¹⁰, Paulo Castro-Chaves¹¹, Maria Teresa Brito¹¹, Muhib Khan¹², Dania Mallick, Aaron Rothstein¹³, Ossama Khazaal¹³, Josefin E Kaufmann¹⁴, Stefan T Engelter¹⁴, Christopher Traenka¹⁴, Diana Aguiar de Sousa¹⁵, Mafalda Soares¹⁶, Sara Rosa¹⁷, Lily W Zhou¹⁸, Preet Gandhi¹⁸, Thalia S Field¹⁸, Steven Mancini¹⁸, Issa Metanis¹⁹, Ronen R Leker¹⁹, Kelly Pan¹, Vishnu Dantu¹, Karl Baumgartner¹, Tina Burton¹, Regina Von Rennenberg²⁰, Christian H Nolte²⁰, Richard Choi²¹, Jason MacDonald²¹, Reza Bavarsad Shahripour²², Xiaofan Guo²³, Malik Ghannam²⁴, Mohammad Almajali²⁴, Edgar A Samaniego²⁴, Sebastian Sanchez²⁴, Bastien Rioux²⁵, Faycal Zine-Eddine²⁵, Alexandre Poppe²⁵, Ana Catarina Fonseca²⁶, Maria Fortuna Baptista²⁶, Diana Cruz²⁶, Michele Romoli²⁷, Giovanna De Marco²⁷, Marco Longoni²⁷, Zafer Keser²⁸, Kim Griffin²⁸, Lindsey Kuohn²⁹, Jennifer Frontera²⁹, Jordan Amar³⁰, James Giles³⁰, Marialuisa Zedde³¹, Rosario Pascarella³², Ilaria Grisendi³¹, Hipolito Nzwalo³³, David S Liebeskind³⁴, Amir Molaie³⁴, Annie Cavalier³⁵, Wayneho Kam³⁶, Brian Mac Grory³⁵, Sami Al Kasab³⁷, Mohammad Anadani³⁷, Kimberly Kicielinski³⁸, Ali Eltatawy³⁹, Lina Chervak³⁹, Roberto Chulluncuy-Rivas³⁹, Yasmin Aziz³⁹, Ekaterina Bakradze⁴⁰, Thanh Lam Tran⁴⁰, Marc Rodrigo-Gisbert⁴¹, Manuel Requena⁴¹, Faddi Saleh Velez⁴², Jorge Ortiz Gracia⁴², Varsha Mudassani⁴³, Adam de Havenon^{44

45}, Venugopalan Y Vishnu⁴⁶, Sridhara Yaddanapudi⁴⁶, Latasha Adams⁴⁶, Abigail Browngoehl⁴⁶, Tamra Ranasinghe⁴⁷, Randy Dunston⁴⁷, Zachary Lynch⁴⁷, Mary Penckofer⁴⁸, James Siegler⁴⁸, Silvia Mayer⁴⁹, Joshua Willey⁴⁹, Adeel Zubair⁴⁴, Yee Kuang Cheng⁴⁴, Richa Sharma⁴⁴, João Pedro Marto⁵⁰, Vítor Mendes Ferreira⁵⁰, Piers Klein⁵¹, Thanh N Nguyen⁵¹, Syed Daniyal Asad⁵², Zoha Sarwat⁵², Anvesh Balabhadra⁵², Shivam Patel⁵², Thais Secchi⁵³, Sheila Martins⁵⁴, Gabriel Mantovani⁵⁴, Young Dae Kim⁵⁵, Balaji Krishnaiah⁵⁶, Cheran Elangovan⁵⁶, Sivani Lingam⁵⁷, Abid Quereshi⁵⁷, Sebastian Fridman⁵⁸, Alonso Alvarado⁵⁸, Farid Khasiyev⁵⁹, Guillermo Linares⁵⁹, Marina Mannino⁶⁰, Valeria Terruso⁶⁰, Sofia Vassilopoulou⁶¹, Vasilis Tentolouris⁶¹, Manuel Martinez-Marino⁶², Victor Carrasco Wall⁶², Fransisca Indraswari⁶³, Sleiman El Jamal⁶³, Shilin Liu⁶⁴, Muhammad Alvi⁶⁵, Farman Ali⁶⁵, Mohammed Sarvath⁶⁵, Rami Z Morsi⁶⁶, Tareq Kass-Hout⁶⁶, Feina Shi⁶⁷, Jinhua Zhang⁶⁷, Dilraj Sokhi⁶⁸, Jamil Said⁶⁸, Alexis N Simpkins⁶⁹, Roberto Gomez⁶⁹, Shayak Sen⁶⁹, Mohammad Ghani⁷⁰, Marwa Elnazeir⁷⁰, Han Xiao⁷¹, Narendra Kala¹, Farhan Khan¹, Christoph Stretz¹, Nahid Mohammadzadeh¹, Eric Goldstein¹, Karen Furie

Affiliations

¹ Department of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S. Yaghi, L.S., D. Mandel, K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N.M., E.G., K.F.).
² Department of Neurology, Atrium Health, Charlotte, NC (C.R.L.G.).
³ Department of Neurology, University of Massachusetts, Chan Medical School, Worcester (N.H., J. Muppa).
⁴ Department of Neurology, University of Minnesota, Minneapolis (M. Affan, O.U.H.L.).
⁵ Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold).
⁶ Department of Neurology, University of Colorado, Denver (S.S.O., R. Crandall).
⁷ Department of Neurology, Weill Cornell Medicine, New York, NY (E.L.).
⁸ Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico City, Mexico (D.L.M., A. Arauz).
⁹ Service de neurologie, Université Caen Normandie, CHU Caen Normandie, France (A.N., M.B., E.T.).
¹⁰ Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., V.B.).
¹¹ Department of Internal Medicine, São João University Hospital, Porto, Portugal (P.C.-C., M.T.B.).
¹² Department of Neurology, Corewell Health, Grand Rapids, MI (M.K., D. Mallic).
¹³ Department of Neurology, University of Pennsylvania, Philadelphia (A.R., O.K.).
¹⁴ Department of Neurology, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, Switzerland (J.E.K., S.T.E., C.T.).
¹⁵ Stroke Center, Centro Hospitalar Universitário Lisboa Central, and Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Portugal (D.A.d.S.).
¹⁶ Department of Neurology (M. Saores), Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
¹⁷ Department of Neuroradiology (S.R.), Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
¹⁸ Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini).
¹⁹ Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (I.M., R.R.L.).
²⁰ Department of Neurology, Charite Universitätsmedizin-Berlin und Center for Stroke Research, Germany (R.V.R., C.H.N.).
²¹ Department of Neurosciences, ChristianaCare, Newark, DE (R. Choi, J. MacDonald.).
²² Department of Neurology, University of California at San Diego (R.B.S.).
²³ Department of Neurology, Loma Linda University, CA (X.G.).
²⁴ Department of Neurology, University of Iowa (M. Ghannam, M. Almajali, E.A.S., S. Sanchez).
²⁵ Department of Neurosciences, Université de Montréal, Canada (B.R., F.Z.-E., A.P.).
²⁶ Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal (A.C.F., M.F.B., D.C.).
²⁷ Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M. Romoli, G.D.M., M.L.).
²⁸ Department of Neurology, Mayo Clinic, Rochester, MN (M.K., Z.K., K.G.).
²⁹ Department of Neurology, NYU Langone Health, New York (L.K., J.F.).
³⁰ Department of Neurology, Washington University, Saint Louis, MO (J.A., J.G.).
³¹ Neurology Unit, Stroke Unit (M.Z., I.G.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy.
³² Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy.
³³ Department of Internal Medicine, Centro Hospital Universitario do Algarve, Faro, Portugal (H.N.).
³⁴ Department of Neurology, University of California at Los Angeles (D.S.L., A.M.).
³⁵ Department of Neurology, Duke University, Durham, NC (A.C., B.M.G.).
³⁶ Comprehensive Stroke Center, University of North Carolina Health Rex, Raleigh (W.K.).
³⁷ Department of Neurology (S.A.K., M. Anadani), Medical University of South Carolina, Charleston.
³⁸ Department of Neurosurgery (K.K.), Medical University of South Carolina, Charleston.
³⁹ Department of Neurology, University of Cincinnati Medical Center, OH (A.E., L.C., R.C.R., Y.A.).
⁴⁰ Department of Neurology, University of Alabama at Birmingham (E.B., T.L.T.).
⁴¹ Department of Neurology, University Hospital Vall d'Hebron, Barcelona, Spain (M.R.G., M. Requena).
⁴² Department of Neurology, University of Oklahoma (F.S.V., J.O.G.).
⁴³ Department of Neurology, Einstein-Jefferson Healthcare Network, Philadelphia, PA (V.M.).
⁴⁴ Department of Neurology, Yale New Haven Hospital, CT (A.d.H., A.Z., Y.K.C., R.S.).
⁴⁵ Department of Neurology, University of Utah, Salt Lake City (A.d.H.).
⁴⁶ Department of Neurology, Thomas Jefferson University, Philadelphia, PA (S. Yaddanapudi, L.A., A. Browngoehl).
⁴⁷ Department of Neurology, Wake Forest Medical Center, NC (T.R., R.D., Z.L.).
⁴⁸ Department of Neurology, Cooper University, Camden, NJ (M.P., J. Siegler).
⁴⁹ Department of Neurology, Columbia University Medical Center, New York, NY (S. Mayer, J.W.).
⁵⁰ Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (J.P.M., V.M.F.).
⁵¹ Department of Neurology, Boston Medical Center, MA (P.K., T.N.N.).
⁵² Department of Neurology, Hartford Hospital, CT (S.D.A., Z.S., A. Balabhadra, S.P.).
⁵³ Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, Brazil (T.S.).
⁵⁴ Department of Neurology, Hospital de Clínicas de Porto Alegre, Brazil (S. Martins, G.M.).
⁵⁵ Department of Neurology, Yonsei University, Seoul, South Korea (Y.D.K.).
⁵⁶ Department of Neurology, University of Tennessee at Memphis (B.K., C.E.).
⁵⁷ Department of Neurology, Kansas University Medical Center (S. Lingam, A.Q.).
⁵⁸ Department of Neurology, Western Ontario University, London, Canada (S.F., A. Alvarado).
⁵⁹ Department of Neurology, Saint Louis University, MO (F. Khasiyev, G.L.).
⁶⁰ Department of Neurology and Stroke Unit, AOOR Villa Sofia-V. Cervello, Palermo, Italy (M.M., V. Terruso).
⁶¹ 1st Department of Neurology, National and Kapodistrian University of Athens, Greece (S.V., V. Tentolouris).
⁶² Department of Neurology, Centro Médico Nacional Siglo XXI IMSS, México City, Mexico (M.M.M., V.C.W.).
⁶³ Department of Neurology, The Miriam Hospital, Providence, RI (F.I., S.E.J.).
⁶⁴ Department of Neurology, University of Science and Technology, Shanghai, China (S. Liu).
⁶⁵ Department of Neurology, West Virginia University (M. Alvi, F.A., M. Sarvath).
⁶⁶ Department of Neurology, University of Chicago, IL (R.Z.M., T.K.-H.).
⁶⁷ Department of Neurology, Sir Run Run Shaw Hospital of Zhejiang University Medical School, Hangzhou, China (F.S., J.Z.).
⁶⁸ Department of Neurology, Aga Khan University, Nairobi, Kenya (D. Sokhi, J. Said).
⁶⁹ Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA (A.S., R.G., S. Sen).
⁷⁰ Department of Neurology, University of Louisville, KY (M. Ghani, M.E.).
⁷¹ Department of Economics, University of California Santa Barbara (H.X.).

PMID: 38335240
DOI: 10.1161/STROKEAHA.123.045731

Free article

Observational Study

Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study

Shadi Yaghi et al. Stroke. 2024 Apr.

Free article

. 2024 Apr;55(4):908-918.

doi: 10.1161/STROKEAHA.123.045731. Epub 2024 Feb 9.

Authors

Affiliations

¹ Department of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S. Yaghi, L.S., D. Mandel, K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N.M., E.G., K.F.).
² Department of Neurology, Atrium Health, Charlotte, NC (C.R.L.G.).
³ Department of Neurology, University of Massachusetts, Chan Medical School, Worcester (N.H., J. Muppa).
⁴ Department of Neurology, University of Minnesota, Minneapolis (M. Affan, O.U.H.L.).
⁵ Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold).
⁶ Department of Neurology, University of Colorado, Denver (S.S.O., R. Crandall).
⁷ Department of Neurology, Weill Cornell Medicine, New York, NY (E.L.).
⁸ Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico City, Mexico (D.L.M., A. Arauz).
⁹ Service de neurologie, Université Caen Normandie, CHU Caen Normandie, France (A.N., M.B., E.T.).
¹⁰ Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., V.B.).
¹¹ Department of Internal Medicine, São João University Hospital, Porto, Portugal (P.C.-C., M.T.B.).
¹² Department of Neurology, Corewell Health, Grand Rapids, MI (M.K., D. Mallic).
¹³ Department of Neurology, University of Pennsylvania, Philadelphia (A.R., O.K.).
¹⁴ Department of Neurology, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, Switzerland (J.E.K., S.T.E., C.T.).
¹⁵ Stroke Center, Centro Hospitalar Universitário Lisboa Central, and Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Portugal (D.A.d.S.).
¹⁶ Department of Neurology (M. Saores), Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
¹⁷ Department of Neuroradiology (S.R.), Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
¹⁸ Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini).
¹⁹ Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (I.M., R.R.L.).
²⁰ Department of Neurology, Charite Universitätsmedizin-Berlin und Center for Stroke Research, Germany (R.V.R., C.H.N.).
²¹ Department of Neurosciences, ChristianaCare, Newark, DE (R. Choi, J. MacDonald.).
²² Department of Neurology, University of California at San Diego (R.B.S.).
²³ Department of Neurology, Loma Linda University, CA (X.G.).
²⁴ Department of Neurology, University of Iowa (M. Ghannam, M. Almajali, E.A.S., S. Sanchez).
²⁵ Department of Neurosciences, Université de Montréal, Canada (B.R., F.Z.-E., A.P.).
²⁶ Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal (A.C.F., M.F.B., D.C.).
²⁷ Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M. Romoli, G.D.M., M.L.).
²⁸ Department of Neurology, Mayo Clinic, Rochester, MN (M.K., Z.K., K.G.).
²⁹ Department of Neurology, NYU Langone Health, New York (L.K., J.F.).
³⁰ Department of Neurology, Washington University, Saint Louis, MO (J.A., J.G.).
³¹ Neurology Unit, Stroke Unit (M.Z., I.G.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy.
³² Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy.
³³ Department of Internal Medicine, Centro Hospital Universitario do Algarve, Faro, Portugal (H.N.).
³⁴ Department of Neurology, University of California at Los Angeles (D.S.L., A.M.).
³⁵ Department of Neurology, Duke University, Durham, NC (A.C., B.M.G.).
³⁶ Comprehensive Stroke Center, University of North Carolina Health Rex, Raleigh (W.K.).
³⁷ Department of Neurology (S.A.K., M. Anadani), Medical University of South Carolina, Charleston.
³⁸ Department of Neurosurgery (K.K.), Medical University of South Carolina, Charleston.
³⁹ Department of Neurology, University of Cincinnati Medical Center, OH (A.E., L.C., R.C.R., Y.A.).
⁴⁰ Department of Neurology, University of Alabama at Birmingham (E.B., T.L.T.).
⁴¹ Department of Neurology, University Hospital Vall d'Hebron, Barcelona, Spain (M.R.G., M. Requena).
⁴² Department of Neurology, University of Oklahoma (F.S.V., J.O.G.).
⁴³ Department of Neurology, Einstein-Jefferson Healthcare Network, Philadelphia, PA (V.M.).
⁴⁴ Department of Neurology, Yale New Haven Hospital, CT (A.d.H., A.Z., Y.K.C., R.S.).
⁴⁵ Department of Neurology, University of Utah, Salt Lake City (A.d.H.).
⁴⁶ Department of Neurology, Thomas Jefferson University, Philadelphia, PA (S. Yaddanapudi, L.A., A. Browngoehl).
⁴⁷ Department of Neurology, Wake Forest Medical Center, NC (T.R., R.D., Z.L.).
⁴⁸ Department of Neurology, Cooper University, Camden, NJ (M.P., J. Siegler).
⁴⁹ Department of Neurology, Columbia University Medical Center, New York, NY (S. Mayer, J.W.).
⁵⁰ Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (J.P.M., V.M.F.).
⁵¹ Department of Neurology, Boston Medical Center, MA (P.K., T.N.N.).
⁵² Department of Neurology, Hartford Hospital, CT (S.D.A., Z.S., A. Balabhadra, S.P.).
⁵³ Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, Brazil (T.S.).
⁵⁴ Department of Neurology, Hospital de Clínicas de Porto Alegre, Brazil (S. Martins, G.M.).
⁵⁵ Department of Neurology, Yonsei University, Seoul, South Korea (Y.D.K.).
⁵⁶ Department of Neurology, University of Tennessee at Memphis (B.K., C.E.).
⁵⁷ Department of Neurology, Kansas University Medical Center (S. Lingam, A.Q.).
⁵⁸ Department of Neurology, Western Ontario University, London, Canada (S.F., A. Alvarado).
⁵⁹ Department of Neurology, Saint Louis University, MO (F. Khasiyev, G.L.).
⁶⁰ Department of Neurology and Stroke Unit, AOOR Villa Sofia-V. Cervello, Palermo, Italy (M.M., V. Terruso).
⁶¹ 1st Department of Neurology, National and Kapodistrian University of Athens, Greece (S.V., V. Tentolouris).
⁶² Department of Neurology, Centro Médico Nacional Siglo XXI IMSS, México City, Mexico (M.M.M., V.C.W.).
⁶³ Department of Neurology, The Miriam Hospital, Providence, RI (F.I., S.E.J.).
⁶⁴ Department of Neurology, University of Science and Technology, Shanghai, China (S. Liu).
⁶⁵ Department of Neurology, West Virginia University (M. Alvi, F.A., M. Sarvath).
⁶⁶ Department of Neurology, University of Chicago, IL (R.Z.M., T.K.-H.).
⁶⁷ Department of Neurology, Sir Run Run Shaw Hospital of Zhejiang University Medical School, Hangzhou, China (F.S., J.Z.).
⁶⁸ Department of Neurology, Aga Khan University, Nairobi, Kenya (D. Sokhi, J. Said).
⁶⁹ Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA (A.S., R.G., S. Sen).
⁷⁰ Department of Neurology, University of Louisville, KY (M. Ghani, M.E.).
⁷¹ Department of Economics, University of California Santa Barbara (H.X.).

PMID: 38335240
DOI: 10.1161/STROKEAHA.123.045731

Abstract

Background: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation.

Methods: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma. The exposure was antithrombotic treatment type (anticoagulation versus antiplatelets), and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with inverse probability of treatment weighting to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an as-treated crossover approach and only included outcomes occurring with the above treatments.

Results: The study included 3636 patients (402 [11.1%] received exclusively anticoagulation and 2453 [67.5%] received exclusively antiplatelets). By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with inverse probability of treatment weighting, compared with antiplatelet therapy, anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted hazard ratio [HR], 0.71 [95% CI, 0.45-1.12]; P=0.145) and by day 180 (adjusted HR, 0.80 [95% CI, 0.28-2.24]; P=0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR, 1.39 [95% CI, 0.35-5.45]; P=0.637) but was by day 180 (adjusted HR, 5.56 [95% CI, 1.53-20.13]; P=0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR, 0.40 [95% CI, 0.18-0.88]; P_interaction=0.009).

Conclusions: Our study does not rule out the benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.

Keywords: anticoagulants; arteries; hemorrhage; ischemic stroke; stroke.

PubMed Disclaimer

Conflict of interest statement

Disclosures Disclosures provided by Dr Nguyen in compliance with American Heart Association annual Journal Editor Disclosure Questionnaire are available at https://www.ahajournals.org/editor-coi-disclosures. Dr Arnold reports compensation from Boehringer Ingelheim, AstraZeneca, Bayer, Bristol-Myers Squibb, Covidien, Daiichi Sankyo, Novartis, Sanofi, Pfizer, Medtronic, Novo Nordisk, and Amgen for consultant services. Dr Lester reports a provisional patent for Methods and compositions for disrupting tau aggregates. Dr Touze reports compensation from Elsevier for other services and employment by Caen. J.E. Kaufman reports grants from Goldschmidt Jacobson-Stiftung. Dr Traenka reports travel support from Bayer Healthcare. Dr Aguiar de Sousa reports compensation from Daiichi Sankyo, Bayer, AstraZeneca, Johnson & Johnson, and Fundação Bial for other services; compensation from the University of British Columbia for data and safety monitoring services; compensation from Organon & Co for consultant services. Dr Rosa reports grants from Merck Sharp & Dohme Corporation. Dr Field reports compensation from HLS Therapeutics, AstraZeneca Canada, and Roche for consultant services; service as a board member for Destine Health; and compensation from the Canadian Medical Protective Association for expert witness services; and grants from Bayer. Dr Leker reports compensation from Medtronic, Ischemaview, Bayer, Abbott Diabetes Care, Biogen, Janssen Biotech, and Boehringer Ingelheim for other services. Dr Nolte reports compensation from Daiichi Sankyo Europe GmbH, Boehringer Ingelheim, Pfizer, Bristol-Myers Squibb, and Alexion Pharmaceuticals for consultant services; and compensation from AstraZeneca, Abbott Canada, Deutsches Zentrum für Neurodegenerative Erkrankungen, Novartis, Portola Pharmaceuticals, Deutsches Zentrum für Herz-Kreislaufforschung, and Novartis for other services. Dr Poppe reports grants from Foundation Brain Canada, Heart and Stroke Foundation of Canada, and Stryker; and compensation from Roche for other services. Dr Liebeskind reports compensation from Medtronic, Genentech, Cerenovus, Stryker, and Rapid Medical Ltd, for consultant services. B. Mac Grory reports grants from the National Institutes of Health; employment by Duke University Medical Center; compensation from Bayer for other services; grants from the American Heart Association, Duke Bass Connections, and the Duke Office of Physician Scientist Development. Dr Al Kasab reports compensation from Stryker for other services and employment by Medical University of South Carolina. Dr Kicielinski reports compensation from Stryker, Penumbra Inc, Medtronic, and MicroVention Inc, for other services; travel support from MicroVention Inc; and employment by Medical University of South Carolina and Elsevier. Dr de Havenon reports stock options in TitinKM and Certus; grants from the National Institutes of Health; and compensation from Novo Nordisk for consultant services. Dr Siegler reports grants from Philips and employment by the University of Chicago. Dr Willey reports compensation from Edwards Lifesciences Corporation and Abbott Fund for end point review committee services; compensation from Uptodate for other services; and compensation from the Abbott Laboratories for consultant services. Dr Sharma reports a provisional patent for a stroke etiology classifier algorithm and grants from the National Institutes of Health Clinical Center. Dr Martins reports compensation from Pfizer, Medtronic, Servier Affaires Medicales, Daiichi Sankyo, Bayer, Novo Nordisk, Novartis, Penumbra Inc, and Boehringer Ingelheim for other services. Dr Simpkins reports grants from the National Institutes of Health. Dr Stretz reports grants from Massachusetts General Hospital. Dr Furie reports compensation from Janssen Biotech for consultant services. The other authors report no conflicts

Comment in

Data Over Dogma in Treatment of Cervical Artery Dissections.
Bernstein RA, Previch L, Caprio FZ. Bernstein RA, et al. Stroke. 2024 Apr;55(4):919-920. doi: 10.1161/STROKEAHA.124.046745. Epub 2024 Mar 25. Stroke. 2024. PMID: 38527153 No abstract available.

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Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study

Affiliations

Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study

Authors

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Abstract

Conflict of interest statement

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