Dissection of cervical arteries: Long-term follow-up study of 130 consecutive cases.
OBJECTIVE
We describe the natural history, functional prognosis and long-term recurrences of patients with dissection of cervical arteries (DCA) in a sequential observational study.


METHODS
We describe 130 patients with angiographically-proven DCA admitted to the Neurology Institute in Mexico City (Mexico), and analyzed clinical and neuroimaging data, treatment and outcome. Treatment with either anticoagulation or aspirin was decided by the primary physician. Primary outcome measures were recurrence (stroke and death) and clinical outcome at 6 months. Follow-up studies were performed to determine recanalization.


RESULTS
Mean age was 35.4 years; 4 patients died (3%) and 126 were followed for 3,906 person/years; 17 patients (13%) had a heralding ischemic cerebral event (6 strokes, 11 TIAS) about 8 days before the diagnosis of DCA. After diagnosis, recurrent ischemic stroke occurred in 6 patients (4.8%) within the 2 first weeks (1.5 persons/1,000 follow-up years). No significant differences were found between aspirin and anticoagulation. Recanalization was more frequent in vertebral dissections. Complete recanalization of vertebral dissections was associated with a favorable prognosis [OR 3.2 (95% CI 1.1-8.8; p = 0.02)].


CONCLUSIONS
In Mexico, DCA affects young adults and may present with a heralding stroke or TIA. We found rare, early ischemic recurrences. Vertebral territory dissections had better prognosis than carotid ones, particularly in patients with demonstrated complete recanalization.
Arauz
Antonio
A
Stroke Clinic of the Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico. arauzg@innn.edu.mx
Hoyos
Leticia
L
Espinoza
Carlos
C
Cantú
Carlos
C
Barinagarrementeria
Fernando
F
Román
Gustavo
G
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D020215:Carotid Artery, Internal, Dissection / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin