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Multicenter Study
. 2025 Jul 1;8(7):e2521539.
doi: 10.1001/jamanetworkopen.2025.21539.

Long-Term Risk of Recurrent Cervical Artery Dissection and Stroke After Pregnancy

Sandro K Fischer  1   2 , Josefin E Kaufmann  1   2 , Tiina M Metso  3 , Turgut Tatlisumak  3   4   5 , Johannes Wischmann  6 , Lars Kellert  6 , Lukas Mayer-Suess  7 , Michael Knoflach  7 , Regina von Rennenberg  8 , Christian H Nolte  8   9 , Cheyenne Lee  10 , Chad M Aldridge  10   11 , Bradford B Worrall  10   11 , Andrew T Weko  10 , Andrew M Southerland  10   11 , Judea P Wiggins  12 , Jennifer J Majersik  12 , Philipp Baumgartner  13 , Susanne Wegener  13 , Issa Metanis  14 , Ronen R Leker  14 , Vanessa Cano-Nigenda  15 , Antonio Arauz  15 , Anabella Frances  16 , Ignacio Bozas  16 , Juan J Martin  16 , Annaelle Zietz  1   2 , Alexandros Polymeris  1   2 , Valerian L Altersberger  2 , Giorgia Abrignani  17 , Paola Castellini  17 , Antonio Genovese  17 , Lilia Latte  17 , Maria Claudia Trapasso  17 , Marialuisa Zedde  18 , Anna Bersano  19 , Giulia Marinoni  19 , Giorgio Silvestrelli  20 , Claudio Baracchini  21 , Francesco Favruzzo  21 , Maurizio Paciaroni  22 , Alessandra Spalloni  23 , Rosalba Patella  23 , Manuel Cappellari  24 , Francesco Valletta  24 , Massimo Del Sette  25 , Davide Sassos  25 , Mauro Gentile  26 , Mauro Magoni  27 , Massimo Gamba  27 , Marina Padroni  28 , Cristiano Azzini  28 , Elisa Giorli  29 , Fabio Melis  30 , Rossana Tassi  31 , Rocco Salvatore Calabrò  32 , Valeria Piras  33 , Maurizio Melis  33 , Alessia Giossi  34 , Sandro Sanguigni  35 , Marina Mannino  36 , Valeria Bignamini  37 , Alessandra Gaiani  37 , Alessandro Adami  38 , Rita Bella  39 , Rosario Pascarella  40 , Philippe Lyrer  2 , Henrik Gensicke  1   2 , Alessandro Pezzini  16   41 , Christopher Traenka  1   2 , Stefan T Engelter  1   2
Affiliations
Multicenter Study

Long-Term Risk of Recurrent Cervical Artery Dissection and Stroke After Pregnancy

Sandro K Fischer et al. JAMA Netw Open. .

Erratum in

  • Errors in Affiliations.
    [No authors listed] [No authors listed] JAMA Netw Open. 2025 Aug 1;8(8):e2532386. doi: 10.1001/jamanetworkopen.2025.32386. JAMA Netw Open. 2025. PMID: 40833699 Free PMC article. No abstract available.

Abstract

Importance: Cervical artery dissection (CeAD) is a leading cause of stroke in young people and can occur during pregnancy. In women with prior CeAD, it is unclear whether future pregnancies increase the risk of recurrent CeAD, stroke, or death.

Objective: To compare the frequency of recurrent CeAD, stroke, or death as a composite outcome between patients with CeAD who became pregnant vs those who did not.

Design, setting, and participants: The Long-Term Risk of Recurrent Cervical Artery Dissection and Stroke After Pregnancy (LONG-RECAP) study was an international, multicenter, registry-based, explorative cohort study with data from May 1, 1990, and April 30, 2023, among patients with CeAD at 33 stroke centers across 9 countries who had at least 6 months of follow-up for whom detailed information was available on absence vs presence of subsequent pregnancies and the occurrence of outcome events.

Exposure: Pregnancy after CeAD.

Main outcomes and measures: Composite of recurrent CeAD, stroke (any type), and death (all causes) during follow-up at least 6 months after initial CeAD. Secondary outcomes were the components of the composite outcome. Cox proportional hazards regression analysis with and without adjustment for age was used to examine the association between pregnancy and outcomes.

Results: Among 1013 female patients with CeAD (median [IQR] age, 42 [35-48] years), 114 (11.3%) became pregnant during a median (IQR) follow-up of 5.3 (2.0-11.3) years. The composite outcome occurred in 10 of 114 patients (8.8%), including 7 patients with recurrent CeADs, 2 with ischemic strokes, and 1 with intracerebral hemorrhage, in the pregnancy group compared with 65 of 899 patients (7.2%), including 32 with recurrent CeAD, 26 with ischemic strokes, 4 with intracerebral hemorrhages, and 5 deaths (2 patients had 2 outcomes), in the nonpregnancy group (unadjusted hazard ratio, 1.08; 95% CI, 0.56-2.08; age-adjusted hazard ratio, 0.77; 95% CI, 0.38-1.56). Five of 10 events in the pregnancy group occurred post partum (4 CeADs and 1 stroke). Age-adjusted hazard ratios for secondary outcomes were 1.03 (95% CI, 0.43-2.46) for recurrent CeAD, 0.53 (95% CI, 0.13-2.12) for ischemic stroke, 1.01 (95% CI, 0.11-9.32) for intracerebral hemorrhage, and 0.90 (95% CI, 0.03-24.88) for death.

Conclusions and relevance: In this cohort study of women with a history of CeAD, becoming pregnant was not associated with an increased risk of recurrent CeAD, stroke, or death. These findings may be helpful for individual counseling and family planning for women with prior CeAD.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Metso reported receiving grants from Emil Aaltonen Foundation, Maud Kuistila Foundation, Orion Farmos Research Foundation, Finnish Medical Foundation, and Helsinki University Central Hospital Research Fund during the conduct of the study. Dr Nolte reported receiving funding for travel or speaker honoraria from Alexion, Astra Zeneca, BMS, Novartis, and Pfizer. Dr Southerland reported receiving grants from AbbVie Pharmaceuticals, American Heart Association, and National Institutes of Health outside the submitted work; in addition, Dr Southerland had a patent for US 10,846,370 B2 issued from Mobile Telemedicin and a patent for 62/620,096 pending for computer vision analysis and served as a paid legal expert, providing medicolegal opinions in stroke and cerebrovascular cases for multiple attorneys and law firms. Dr Leker reported serving on the Filterlex Advisory Board and the Bayer Steering Committee for Oceanic Stroke, receiving speaker’s honoraria from Medison Israel, IscemaView, and Neopharm Israel, serving as a principal investigator for Shionogi, and receiving grants from Horizon 2022 EU and Chantal and Peritz Scheinberg Cerebrovascular Research Fund outside the submitted work. Dr Paciaroni reported serving on speaker’s bureaus for Sanofi, iRhythm, and Daiiki Sankyo outside the submitted work. Dr Tassi reported receiving personal fees from Boehringer Ingelheim and AstraZeneca outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Main and Secondary Outcomes
Figure 2.
Figure 2.. Cumulative Incidence of Recurrent Cervical Artery Dissection During Follow-Up
The solid lines represent the estimated cumulative incidence of recurrent cervical artery dissection for each group, with the shaded areas indicating the corresponding 95% CIs.
See this image and copyright information in PMC

References

    1. Nedeltchev K, der Maur TA, Georgiadis D, et al. Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry. 2005;76(2):191-195. doi: 10.1136/jnnp.2004.040543 - DOI - PMC - PubMed
    1. Béjot Y, Daubail B, Debette S, Durier J, Giroud M. Incidence and outcome of cerebrovascular events related to cervical artery dissection: the Dijon Stroke Registry. Int J Stroke. 2014;9(7):879-882. doi: 10.1111/ijs.12154 - DOI - PubMed
    1. Lamy C, Hamon JB, Coste J, Mas JL; French Study Group on Stroke in Pregnancy . Ischemic stroke in young women: risk of recurrence during subsequent pregnancies. Neurology. 2000;55(2):269-274. doi: 10.1212/WNL.55.2.269 - DOI - PubMed
    1. Reinhard M, Munz M, von Kannen AL, Griesser-Leute HJ, Dittrich R, Engelter ST. Risk of recurrent cervical artery dissection during pregnancy, childbirth and puerperium. Eur J Neurol. 2015;22(4):736-739. doi: 10.1111/ene.12602 - DOI - PubMed
    1. Salehi Omran S, Parikh NS, Poisson S, et al. Association between pregnancy and cervical artery dissection. Ann Neurol. 2020;88(3):596-602. doi: 10.1002/ana.25813 - DOI - PMC - PubMed

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