Cervical artery dissection: risk factors, treatment, and outcome; a 5-year experience from a tertiary care center.

BACKGROUND: Cervical artery dissection (CAD) is a common cause of stroke in young individuals. Risk factors, treatment, and outcome of CAD are not well established. Our aim is to identify risk factors, outcome, and discuss treatment of CAD.

METHODS: We reviewed medical records of patients seen at our institution between 2004 and 2009, using ICD-9 codes for CAD, for risk factors, treatment, type, and outcome. Poor outcome was defined as modified Rankin Scale (mRS) score within 6 months of >1 or recurrent stroke or transient ischemic attack (TIA).

RESULTS: A total of 47 patients were identified. Twenty-four patients had spontaneous dissections (52%); 30 (63%) involved the carotid. As compared with spontaneous dissections, traumatic dissections occurred in younger patients (mean age 41.0 vs. 47.7 years, p = .064), were more likely to involve the vertebral artery (52% vs. 21%, p = .036, and caused less neurological deficits on presentation (48% vs. 75%, p = .075). Conversely, spontaneous dissections were more likely to occur in patients with hypertension (63% vs. 30%, p = .041) and hypercholesterolemia (46% vs. 9%, p = .008). Patients having no stroke had better outcomes (100% vs. 54%, p < .001). Anticoagulation was used in 17 patients (36%) and antiplatelets in 31 (64%). Outcome and adverse events were similar in the two groups.

CONCLUSION: Hypertension and hypercholesterolemia were risk factors in spontaneous dissections, speaking for vascular wall abnormalities as potential contributors to pathophysiology of CAD. There was no evidence supporting one type of treatment over the other. A large ongoing prospective study should quell this controversy.