Recurrent Stroke After Cervical Artery Dissection

Christian Weimar (1) , Klaus Kraywinkel (2) , Christoph Hagemeister (3) , Anton Haass (4) , Freimuth Brunner (5) , Christian Haverkamp (6) , Zaza Katsarava (1) , Elisabeth Schmid (7) , Hans-Christoph Diener (1)

1 Universität Duisburg-Essen = University of Duisburg-Essen [Essen]
2 RKI - Robert Koch Institute [Berlin]
3 Evangelisches Krankenhaus Bielefeld
4 University of Saarland, Homburg
5 Klinikum Bremen-Mitte
6 University of Freiburg [Freiburg]
7 Bürgerhospital Stuttgart

Objective: Cervical artery dissection (CAD) accounts for 10-20% of all strokes in young adults but no randomized controlled trial has investigated best secondary prevention after ischemic stroke or transient ischemic attack (TIA). Because only small patients numbers with CAD have been prospectively documented and followed-up, we aimed to investigate the prognosis under various prevention regimens. Methods: 30 German departments of Neurology with acute stroke units prospectively documented 250 patients with acute ischemic stroke or TIA due to CAD. A central follow-up (median 31 months) assessed recurrent stroke, recurrent CAD and death in 198 patients. Results: CAD was found more often in the carotid arteries (52.0%) than in the vertebral arteries (46.8%). Thirteen patients (5.2%, CI 3.1-8.6%) suffered a recurrent stroke during the acute hospital stay. The rate of recurrent CAD during the first year was 1.7% (95% CI 0.3- 3.6%). The cumulative recurrent stroke rate during the first year was 10.7% (95% CI 6.5 – 14.9%) and 14.0% (95% CI 8.9-19.1%) over three years. After discharge, the rate of recurrent stroke up to 6 months in patients treated with anticoagulants was 2.0% (95% CI 0.6-7.1%) and in those treated with antiplatelets 16.7% (95% CI 5.8-39.2 %) which was statistically significant (HR 0.11; CI 0.02-0.69, p=0.02). Conclusions: Our observational study confirms a high risk of early recurrent stroke following acute IS or TIA due to CAD. Whether anticoagulation provides any benefit over antiplatelets needs to be investigated in a randomized controlled trial.

Mots clés: ARTERIAL DISSECTION; STROKE

Christian Weimar, Klaus Kraywinkel, Christoph Hagemeister, Anton Haass, Freimuth Brunner, et al.. Recurrent Stroke After Cervical Artery Dissection. Journal of Neurology, Neurosurgery and Psychiatry, 2010, 81 (8), pp.869. ⟨10.1136/jnnp.2009.192153⟩. ⟨hal-00562294⟩