title: Prognosis of carotid dissecting aneurysms: Results from CADISS and a systematic review.
abstract: OBJECTIVE
  To determine the natural history of dissecting aneurysm (DA) and whether DA is associated with an increased recurrent stroke risk and whether type of antithrombotic drugs (antiplatelets vs anticoagulants) modifies the persistence or development of DA.
  
  
  METHODS
  We included 264 patients with extracranial cervical artery dissection (CAD) from the Cervical Artery Dissection in Stroke Study (CADISS), a multicenter prospective study that compared antiplatelet with anticoagulation therapy. Logistic regression was used to estimate age- and sex-adjusted odds ratios. We conducted a systematic review of published studies assessing the natural history of DA and stroke risk in patients with non-surgically-treated extracranial CAD with DA.
  
  
  RESULTS
  In CADISS, DA was present in 24 of 264 patients at baseline. In 36 of 248 patients with follow-up neuroimaging at 3 months, 12 of the 24 baseline DAs persisted, and 24 new DA had developed. There was no association between treatment allocation (antiplatelets vs anticoagulants) and whether DA at baseline persisted at follow-up or whether new DA developed. During 12 months of follow-up, stroke occurred in 1 of 48 patients with DA and in 7 of 216 patients without DA (age- and sex-adjusted odds ratio 0.84; 95% confidence interval 0.10-7.31;p= 0.88). Published studies, mainly retrospective, showed a similarly low risk of stroke and no evidence of an increased stroke rate in patients with DA.
  
  
  CONCLUSIONS
  The results of CADISS provide evidence suggesting that DAs may have benign prognosis and therefore medical treatment should be considered.
authors.affiliation: From the Stroke Research Group (S.C.L., H.S.M.), Department of Clinical Neurosciences, University of Cambridge; Primary Care and Public Heath (A.K.), School of Public Health, Imperial College London; Neuroradiology (J.M.), Atkinson Morley Neuroscience Centre, St. George's Healthcare Foundation Trust, London, UK; Department of Neurology (C.L.), John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Australia; and St. George's (J.W.N.), University of London, UK.
authors.forename: Susanna C
authors.initials: SC
authors.lastname: Larsson
authors.affiliation: From the Stroke Research Group (S.C.L., H.S.M.), Department of Clinical Neurosciences, University of Cambridge; Primary Care and Public Heath (A.K.), School of Public Health, Imperial College London; Neuroradiology (J.M.), Atkinson Morley Neuroscience Centre, St. George's Healthcare Foundation Trust, London, UK; Department of Neurology (C.L.), John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Australia; and St. George's (J.W.N.), University of London, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: King
authors.affiliation: From the Stroke Research Group (S.C.L., H.S.M.), Department of Clinical Neurosciences, University of Cambridge; Primary Care and Public Heath (A.K.), School of Public Health, Imperial College London; Neuroradiology (J.M.), Atkinson Morley Neuroscience Centre, St. George's Healthcare Foundation Trust, London, UK; Department of Neurology (C.L.), John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Australia; and St. George's (J.W.N.), University of London, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Madigan
authors.affiliation: From the Stroke Research Group (S.C.L., H.S.M.), Department of Clinical Neurosciences, University of Cambridge; Primary Care and Public Heath (A.K.), School of Public Health, Imperial College London; Neuroradiology (J.M.), Atkinson Morley Neuroscience Centre, St. George's Healthcare Foundation Trust, London, UK; Department of Neurology (C.L.), John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Australia; and St. George's (J.W.N.), University of London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
authors.affiliation: From the Stroke Research Group (S.C.L., H.S.M.), Department of Clinical Neurosciences, University of Cambridge; Primary Care and Public Heath (A.K.), School of Public Health, Imperial College London; Neuroradiology (J.M.), Atkinson Morley Neuroscience Centre, St. George's Healthcare Foundation Trust, London, UK; Department of Neurology (C.L.), John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Australia; and St. George's (J.W.N.), University of London, UK.
authors.forename: John W
authors.initials: JW
authors.lastname: Norris
authors.affiliation: From the Stroke Research Group (S.C.L., H.S.M.), Department of Clinical Neurosciences, University of Cambridge; Primary Care and Public Heath (A.K.), School of Public Health, Imperial College London; Neuroradiology (J.M.), Atkinson Morley Neuroscience Centre, St. George's Healthcare Foundation Trust, London, UK; Department of Neurology (C.L.), John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Australia; and St. George's (J.W.N.), University of London, UK. hsm32@medschl.cam.ac.uk.
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Markus
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D000925:Anticoagulants / Q000627:therapeutic use; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D020212:Carotid Artery Injuries / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors