TY - JOUR
T1 - Determinants of neurologic deterioration and stroke-free survival after spontaneous cervicocranial dissections
T2 - A multicenter study
AU - Hassan, Ameer E.
AU - Jadhav, Vikram
AU - Zacharatos, Haralabos
AU - Chaudhry, Saqib A.
AU - Rodriguez, Gustavo J.
AU - Mohammad, Yousef M.
AU - Suri, M. Fareed K.
AU - Tariq, Nauman
AU - Vazquez, Gabriela
AU - Tummala, Ramachandra P.
AU - Taylor, Robert A.
AU - Qureshi, Adnan I.
PY - 2013
Y1 - 2013
N2 - Patients with spontaneous cervicocranial dissection (SCCD) may experience new or recurrent ischemic events despite antiplatelet or anticoagulant therapy. Treatment with stent placement is an available option; however, the literature on patient selection is limited. Thus, identifying patients at high risk for neurologic deterioration after SCCD is of critical importance. The present study examined the rate of neurologic deterioration in medically treated patients with SCCD and evaluated demographic, clinical, and radiologic factors affecting this deterioration. We retrospectively identified consecutive patients with SCCD over a 7-year period from 3 medical institutions, and evaluated the relationships between demographic data, clinical characteristics, and angiographical findings and subsequent neurologic outcomes. Neurologic deterioration was defined as transient ischemic attack (TIA), ischemic stroke, or death occurring during hospitalization or within 1 year of diagnosis. Kaplan-Meier curves were used to determine neurologic event-free survival up to 12 months. A total of 69 patients (mean age, 47.8 ± 14 years; 45 males) with SCCD were included in the study. Eleven patients (16%) experienced in-hospital neurologic deterioration (TIA in 9, ischemic stroke in 1) or death (1 patient). An additional 8 patients developed neurologic deterioration within 1 year after discharge (TIA in 5, ischemic stroke in 2, and death in 1). The overall 1-year event-free survival rate was 72%. Women (P =.046), patients with involvement of both vertebral arteries (P =.02), and those with intracranial arterial involvement (P =.018) had significantly higher rates of neurologic deterioration. Our findings indicate that neurologic deterioration is relatively common after SCCD despite medical treatment in women, patients with bilateral vertebral artery involvement, and those with intracranial vessel involvement.
AB - Patients with spontaneous cervicocranial dissection (SCCD) may experience new or recurrent ischemic events despite antiplatelet or anticoagulant therapy. Treatment with stent placement is an available option; however, the literature on patient selection is limited. Thus, identifying patients at high risk for neurologic deterioration after SCCD is of critical importance. The present study examined the rate of neurologic deterioration in medically treated patients with SCCD and evaluated demographic, clinical, and radiologic factors affecting this deterioration. We retrospectively identified consecutive patients with SCCD over a 7-year period from 3 medical institutions, and evaluated the relationships between demographic data, clinical characteristics, and angiographical findings and subsequent neurologic outcomes. Neurologic deterioration was defined as transient ischemic attack (TIA), ischemic stroke, or death occurring during hospitalization or within 1 year of diagnosis. Kaplan-Meier curves were used to determine neurologic event-free survival up to 12 months. A total of 69 patients (mean age, 47.8 ± 14 years; 45 males) with SCCD were included in the study. Eleven patients (16%) experienced in-hospital neurologic deterioration (TIA in 9, ischemic stroke in 1) or death (1 patient). An additional 8 patients developed neurologic deterioration within 1 year after discharge (TIA in 5, ischemic stroke in 2, and death in 1). The overall 1-year event-free survival rate was 72%. Women (P =.046), patients with involvement of both vertebral arteries (P =.02), and those with intracranial arterial involvement (P =.018) had significantly higher rates of neurologic deterioration. Our findings indicate that neurologic deterioration is relatively common after SCCD despite medical treatment in women, patients with bilateral vertebral artery involvement, and those with intracranial vessel involvement.
KW - Carotid and vertebral artery dissection
KW - event free survival
UR - http://www.scopus.com/inward/record.url?scp=84877048210&partnerID=8YFLogxK
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U2 - 10.1016/j.jstrokecerebrovasdis.2011.09.017
DO - 10.1016/j.jstrokecerebrovasdis.2011.09.017
M3 - Article
C2 - 22079562
AN - SCOPUS:84877048210
SN - 1052-3057
VL - 22
SP - 389
EP - 396
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 4
ER -