Long-Term Risk of Recurrent Cervical Artery Dissection and Stroke After Pregnancy.
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Fischer Sandro K, Kaufmann Josefin E, Metso Tiina M, Tatlisumak Turgut, Wischmann Johannes, Kellert Lars, Mayer-Suess Lukas, Knoflach Michael, von Rennenberg Regina, Nolte Christian H, Lee Cheyenne, Aldridge Chad M, Worrall Bradford B, Weko Andrew T, Southerland Andrew M, Wiggins Judea P, Majersik Jennifer J, Baumgartner Philipp, Wegener Susanne, Metanis Issa, Leker Ronen R, Cano-Nigenda Vanessa, Arauz Antonio, Frances Anabella, Bozas Ignacio, Martin Juan J, Zietz Annaelle, Polymeris Alexandros, Altersberger Valerian L, Abrignani Giorgia, Castellini Paola, Genovese Antonio, Latte Lilia, Trapasso Maria Claudia, Zedde Marialuisa, Bersano Anna, Marinoni Giulia, Silvestrelli Giorgio, Baracchini Claudio, Favruzzo Francesco, Paciaroni Maurizio, Spalloni Alessandra, Patella Rosalba, Cappellari Manuel, Valletta Francesco, Del Sette Massimo, Sassos Davide, Gentile Mauro, Magoni Mauro, Gamba Massimo, Padroni Marina, Azzini Cristiano, Giorli Elisa, Melis Fabio, Tassi Rossana, Calabrò Rocco Salvatore, Piras Valeria, Melis Maurizio, Giossi Alessia, Sanguigni Sandro, Mannino Marina, Bignamini Valeria, Gaiani Alessandra, Adami Alessandro, Bella Rita, Pascarella Rosario, Lyrer Philippe, Gensicke Henrik, Pezzini Alessandro, Traenka Christopher, Engelter Stefan T
Аннотация
OBJECTIVE: To compare the frequency of recurrent CeAD, stroke, or death as a composite outcome between patients with CeAD who became pregnant vs those who did not.
DESIGN, SETTING, AND PARTICIPANTS: The Long-Term Risk of Recurrent Cervical Artery Dissection and Stroke After Pregnancy (LONG-RECAP) study was an international, multicenter, registry-based, explorative cohort study with data from May 1, 1990, and April 30, 2023, among patients with CeAD at 33 stroke centers across 9 countries who had at least 6 months of follow-up for whom detailed information was available on absence vs presence of subsequent pregnancies and the occurrence of outcome events.
EXPOSURE: Pregnancy after CeAD.
MAIN OUTCOMES AND MEASURES: Composite of recurrent CeAD, stroke (any type), and death (all causes) during follow-up at least 6 months after initial CeAD. Secondary outcomes were the components of the composite outcome. Cox proportional hazards regression analysis with and without adjustment for age was used to examine the association between pregnancy and outcomes.
RESULTS: Among 1013 female patients with CeAD (median [IQR] age, 42 [35-48] years), 114 (11.3%) became pregnant during a median (IQR) follow-up of 5.3 (2.0-11.3) years. The composite outcome occurred in 10 of 114 patients (8.8%), including 7 patients with recurrent CeADs, 2 with ischemic strokes, and 1 with intracerebral hemorrhage, in the pregnancy group compared with 65 of 899 patients (7.2%), including 32 with recurrent CeAD, 26 with ischemic strokes, 4 with intracerebral hemorrhages, and 5 deaths (2 patients had 2 outcomes), in the nonpregnancy group (unadjusted hazard ratio, 1.08; 95% CI, 0.56-2.08; age-adjusted hazard ratio, 0.77; 95% CI, 0.38-1.56). Five of 10 events in the pregnancy group occurred post partum (4 CeADs and 1 stroke). Age-adjusted hazard ratios for secondary outcomes were 1.03 (95% CI, 0.43-2.46) for recurrent CeAD, 0.53 (95% CI, 0.13-2.12) for ischemic stroke, 1.01 (95% CI, 0.11-9.32) for intracerebral hemorrhage, and 0.90 (95% CI, 0.03-24.88) for death.
CONCLUSIONS AND RELEVANCE: In this cohort study of women with a history of CeAD, becoming pregnant was not associated with an increased risk of recurrent CeAD, stroke, or death. These findings may be helpful for individual counseling and family planning for women with prior CeAD.