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Title: Artery occlusion independently predicts unfavorable outcome in cervical artery dissection.
Austin Authors: Traenka, Christopher;Grond-Ginsbach, Caspar;Goeggel Simonetti, Barbara;Metso, Tiina M;Debette, Stéphanie;Pezzini, Alessandro;Kloss, Manja;Majersik, Jennifer J;Southerland, Andrew M;Leys, Didier;Baumgartner, Ralf;Caso, Valeria;Béjot, Yannick;De Marchis, Gian Marco;Fischer, Urs;Polymeris, Alexandros;Sarikaya, Hakan;Thijs, Vincent N ;Worrall, Bradford B;Bersano, Anna;Brandt, Tobias;Gensicke, Henrik;Bonati, Leo H;Touzeé, Emmanuel;Martin, Juan J;Chabriat, Hugues;Tatlisumak, Turgut;Arnold, Marcel;Engelter, Stefan T;Lyrer, Philippe
Affiliation: Department of Clinical Neuroscience Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
Swiss National Accident Insurance Institution, Lucerne, Switzerland
Normandie Université, Université Caen Normandie, Inserm U1037, Department of Neurology, CHU Caen Normandie, France
Department of Neurology, CH Sainte-Anne, University Paris Descartes, France
Department of Neurology, Sanatorio Allende, Cordoba, Argentina
Department of Neurology, Lariboisière Hospital, Paris, France
Department of Neurology, Sahlgrenska University Hospital, Sweden
Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
Neurorehabilitation Unit, University of Basel, Basel, Switzerland
University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland
Departments of Neurology and Vascular and Endovascular Surgery, Heidelberg University Hospital, Germany
Department of Neurology, University Hospital Bern, Bellinzona, Switzerland
Ospedale San Giovanni, Bellinzona, Switzerland
Department of Neurology, Helsinki University Central Hospital, Finland
Department of Neurology, Bordeaux University Hospital, France
Inserm U1219 (S.D.), Bordeaux, France
University of Bordeaux, France
Department of Neurology, Boston University School of Medicine, MA, USA
Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy
Department of Neurology, University of Utah, Salt Lake City, USA
Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville, USA
Univ-Lille, Inserm U1171, CHU Lille, France
Neuro Center, Clinic Hirslanden, Zurich, Switzerland
Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Italy
Centre Hospitalier Universitaire Dijon Bourgogne, EA7460, Pathophysiology and Epidemiology of Cardio-Cerebro-Vascular Diseases, University of Burgundy, Dijon, France
Department of Neurology, University Hospital of Zurich, Switzerland
Stroke Theme, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Cerebrovascular Unit Fondazione IRCCS Istituto Neurologico Carlo Besta (A.B.), Milan, Italy
Issue Date: 2020 2019-11-22
Publication information: Neurology 2020; 94(2): e170-e180
Abstract: To assess the impact of dissected artery occlusion (DAO) on functional outcome and complications in patients with cervical artery dissection (CeAD). We analyzed combined individual patient data from 3 multicenter cohorts of consecutive patients with CeAD (the Cervical Artery Dissection and Ischemic Stroke Patients [CADISP]-Plus consortium dataset). Patients with data on DAO and functional outcome were included. We compared patients with DAO to those without DAO. Primary outcome was favorable functional outcome (i.e., modified Rankin Scale [mRS] score 0-1) measured 3-6 months from baseline. Secondary outcomes included delayed cerebral ischemia, major hemorrhage, recurrent CeAD, and death. We performed univariate and multivariable binary logistic regression analyses and calculated odds ratios (OR) with 95% confidence intervals (CI), with adjustment for potential confounders. Of 2,148 patients (median age 45 years [interquartile range (IQR) 38-52], 43.6% women), 728 (33.9%) had DAO. Patients with DAO more frequently presented with cerebral ischemia (84.6% vs 58.5%, p < 0.001). Patients with DAO were less likely to have favorable outcome when compared to patients without DAO (mRS 0-1: 59.6% vs 80.1%, punadjusted < 0.001). After adjustment for age, sex, and initial stroke severity, DAO was independently associated with less favorable outcome (mRS 0-1: OR 0.65, CI 0.50-0.84, p = 0.001). Delayed cerebral ischemia occurred more frequently in patients with DAO than in patients without DAO (4.5% vs 2.9%, p = 0.059). DAO independently predicts less favorable functional outcome in patients with CeAD. Further research on vessel patency, collateral status and effects of revascularization therapies particularly in patients with DAO is warranted.
DOI: 10.1212/WNL.0000000000008654
ORCID: 0000-0002-3646-358X
PubMed URL: 31757869
Type: Journal Article
Appears in Collections:Journal articles

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