Cervical Artery Dissection Diagnosed Following Chiropractic Cervical Manipulation: A STOP-CAD Subanalysis.
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Aleyadeh Rozaleen, Zedde Marialuisa, Marto Joao P, Henninger Nils, Said Jamil, Frontera Jennifer A, Sharma Richa, Leker Ronen R, Secchi Thais L, Indraswari Fransisca, Quereshi Abid Y, Zhou Lily W, Poppe Alexandre Y, Nzwalo Hipolito, Wall Victor C, Fonseca Ana C, Klein Piers, Liebeskind David S, Martins Sheila C O, Ghannam Malik, Dantu Vishnu, Ortiz Gracia Jorge G, De Marco Giovanna, Bakradze Ekaterina, Penckofer Mary, Balabhadra Anvesh, Omran Setareh S, Chang Christopher, Leon Guerrero Christopher R, Muddasani Varsha, von Rennenberg Regina, Guo Xiaofan, Elangovan Cheran, AlMajali Mohammad, Velez Faddi S, Shahripour Reza B, Mandel Daniel M, Zubair Adeel, Elnazeir Marwa, Krishnaiah Balaji, Stretz Christoph, Yaghi Shadi, Maalouf Nancy
Аннотация
METHODS: We analyzed patients in the multicenter STOP-CAD registry (n=4023) to identify CeAD cases diagnosed after chiropractic cervical manipulation. Demographics and clinical features were compared between manipulation-associated and nonmanipulation-associated cases using χ 2 and t tests. Multivariable logistic regression identified key factors associated with manipulation-related CeAD.
RESULTS: About 1 in 20 CeAD cases in this registry reported antecedent cervical manipulation. In multivariable binary logistic regression, compared with patients without prior manipulation, those with prior manipulation were younger (OR per year 0.98, 95% CI: 0.97-0.99, P =0.014), more often female (OR: 1.64, 95% CI: 1.21-2.23, P =0.001), less often diabetic (OR: 0.24, 95% CI: 0.08-0.78, P =0.018), presented with neck pain (OR: 2.80, 95% CI: 2.08-3.77, P <0.001), and had higher odds of isolated vertebral artery dissection (OR: 2.15, 95% CI: 1.57-2.94, P <0.001). Recurrent ischemic stroke rates were similar between groups.
CONCLUSIONS: Given the very high number of manipulations performed annually, the absolute risk of secondary CeAD is extremely low. Manipulation-associated cases have distinct clinical features, occurring more often in younger women with vertebral dissections. Whether manipulation acts as a precipitating trigger or patients with early CeAD symptoms seek manipulation remains unresolved.