Early change and new onset of vascular pathology in cervical artery dissection: implications for surveillance.
Antithrombotic therapy is central to stroke prevention after spontaneous cervical artery dissection (sCAD), but its efficacy may depend on the underlying vascular morphology. We examined the temporal course of vascular changes after sCAD.
Consecutive patients with first-time sCAD underwent prospective serial duplex sonography for up to 10 years. In this retrospective cohort analysis, pathology change was defined as recanalisation of an occluded artery or progression from stenosis to occlusion. New pathology resulting from dissection recurrence was considered if an occlusion occurred in the presence of pre-existing stenosis or vice versa.
In total, 159 patients (83 men; mean age 44.8 years) with first-time sCAD were followed-up starting 1.3 days (median) after symptom onset. Bilateral dissections occurred in 6 patients and recurrent dissections in 26 arteries, resulting in follow-up of 191 arteries (108 internal carotid, 83 vertebral). Recanalisation occurred in 40/80 occluded arteries (cumulative rate 70.4%), whereas progression to occlusion occurred in 9/109 stenosed arteries (10.0%). All changes except one (recanalisation) occurred within 4 months. Recurrent dissection occurred within 6 weeks in 20 patients (14.7%) and between 2 and 7 years in 7 patients (13.7%). Overall, 62 vascular changes or new pathologies were observed in 50 patients (31.4%), with 42 occurring within the first 6 weeks.
Under intensive surveillance, vessel morphology after sCAD is highly dynamic during the early phase, with frequent recanalisation and recurrent dissection. Structured early vascular follow-up may be important if evolving vessel morphology is to guide future individualised antithrombotic treatment strategies.
Consecutive patients with first-time sCAD underwent prospective serial duplex sonography for up to 10 years. In this retrospective cohort analysis, pathology change was defined as recanalisation of an occluded artery or progression from stenosis to occlusion. New pathology resulting from dissection recurrence was considered if an occlusion occurred in the presence of pre-existing stenosis or vice versa.
In total, 159 patients (83 men; mean age 44.8 years) with first-time sCAD were followed-up starting 1.3 days (median) after symptom onset. Bilateral dissections occurred in 6 patients and recurrent dissections in 26 arteries, resulting in follow-up of 191 arteries (108 internal carotid, 83 vertebral). Recanalisation occurred in 40/80 occluded arteries (cumulative rate 70.4%), whereas progression to occlusion occurred in 9/109 stenosed arteries (10.0%). All changes except one (recanalisation) occurred within 4 months. Recurrent dissection occurred within 6 weeks in 20 patients (14.7%) and between 2 and 7 years in 7 patients (13.7%). Overall, 62 vascular changes or new pathologies were observed in 50 patients (31.4%), with 42 occurring within the first 6 weeks.
Under intensive surveillance, vessel morphology after sCAD is highly dynamic during the early phase, with frequent recanalisation and recurrent dissection. Structured early vascular follow-up may be important if evolving vessel morphology is to guide future individualised antithrombotic treatment strategies.
Authors
Seihu Seihu, Hofmann Hofmann, Dömges Dömges, Cangür Cangür, Döltz Döltz, Neumann Neumann, Eue Eue, Knörnschild Knörnschild, Behme Behme, Schreiber Schreiber, Görtler Görtler, For The Tasc-San Network For The Tasc-San Network
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