Risk Profile of Patients with Spontaneous Cervical Artery Dissection.
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Del Zotto Elisabetta, Grassi Mario, Zedde Marialuisa, Zini Andrea, Bersano Anna, Gandolfo Carlo, Silvestrelli Giorgio, Baracchini Claudio, Cerrato Paolo, Lodigiani Corrado, Marcheselli Simona, Paciaroni Maurizio, Spalloni Alessandra, Cappellari Manuel, Del Sette Massimo, Cavallini Anna, Lotti Enrico Maria, Delodovici Maria Luisa, Gentile Mauro, Magoni Mauro, Padroni Marina, Azzini Cristiano, Calloni Maria Vittoria, Giorli Elisa, Braga Massimiliano, La Spina Paolo, Melis Fabio, Tassi Rossana, Terruso Valeria, Calabrò Rocco Salvatore, Piras Valeria, Giossi Alessia, Sanguigni Sandro, Zanferrari Carla, Mannino Marina, Colombo Irene, Dallocchio Carlo, Nencini Patrizia, Bignamini Valeria, Adami Alessandro, Bella Rita, Pascarella Rosario, Keser Zafer, Pezzini Alessandro, Italian Project on Stroke in Young Adults-Cervical Artery Dissection, (IPSYS CeAD) Research Group
Аннотация
METHODS AND RESULTS: In the setting of the Italian Project on Stroke in Young Adults Cervical Artery Dissection (IPSYS CeAD), we compared the characteristics of 1,468 patients with sCeAD (mean age = 47.3 ± 11.3 years, men = 56.7%) prospectively recruited at 39 Italian centers with those of 2 control groups, composed of (1) patients whose ischemic stroke was caused by mechanisms other than dissection (non-CeAD IS) selected from the prospective IPSYS registry and Brescia Stroke Registry and (2) stroke-free individuals selected from the staff members of participating hospitals, matched 1:1:1 by sex, age, and race. Compared to stroke-free subjects, patients with sCeAD were more likely to be hypertensive (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.37-1.98), to have personal history of migraine with aura (OR = 2.45, 95% CI = 1.74-3.34), without aura (OR = 2.67, 95% CI = 2.15-3.32), and family history of vascular disease in first-degree relatives (OR = 1.69, 95% CI = 1.39-2.05), and less likely to be diabetic (OR = 0.65, 95% CI = 0.47-0.91), hypercholesterolemic (OR = 0.75, 95% CI = 0.62-0.91), and obese (OR = 0.41, 95% CI = 0.31-0.54). Migraine without aura was also associated with sCeAD (OR = 1.81, 95% CI = 1.47-2.22) in comparison with patients with non-CeAD IS. In the subgroup of patients with migraine, patients with sCeAD had higher frequency of migraine attacks and were less likely to take anti-migraine preventive medications, especially beta-blockers, compared with the other groups.
INTERPRETATION: The risk of sCeAD is influenced by migraine, especially migraine without aura, more than by other factors, increases with increasing frequency of attacks, and seems to be reduced by migraine preventive medications, namely beta-blockers. ANN NEUROL 2023;94:585-595.