[Clinical and imaging characteristics of carotid artery dissection-induced stroke in young adults associated with elongated styloid process].

A retrospective analysis was conducted on 36 young stroke patients with carotid artery dissection(CAD) enrolled from the Second Affiliated Hospital of Soochow University from January 2015 to December 2023. According to styloid length (>3 cm) and abnormal angulation, the patients were divided into the Elongated Styloid Process (ESP)-induced CAD group (ESP group, 11 cases) and the non-ESP-induced CAD group (NESP group, 25 cases). The demographic characteristics, clinical manifestations, laboratory index, imaging features, and 1-year follow-up outcomes were compared. 31 male and 5 female patients aged [M(Q1,Q3)] 41(36, 44) years were enrolled in the study. 30.6% (11/36) of CAD-related young stroke patients have ESP. The ESP group showed higher rates of head/neck pain (6/11 vs 1/25, P=0.006), and higher levels of creatinine [73.0(59.0,77.0) μmol/L vs 59.0(53.0,66.0) μmol/L, P=0.010] and homocysteine [(18.6±18.2) μmol/L vs (2.4±0.7) μmol/L, P=0.020], but lower levels of admission glucose [5.3(4.7,7.6) mmol/L vs 13.6(9.3,17.3) mmol/L, P<0.001] and fibrinogen [2.8(2.5, 3.5) g/L vs 6.4(5.2,6.8) g/L, P<0.001] than those in the NESP group. In terms of imaging data, the ESP group was mainly characterized by dissecting aneurysm (4/11) and "string-of-pearls" signs (4/11), without double-lumen sign. During the 1-year follow-up, 5 cases in the ESP group achieved favorable dissection repair (5/11), and 1 case developed recurrent cerebral infarction (1/11). ESP screening should be emphasized in young stroke patients with CAD, especially those with hyperhomocysteinemia and head/neck pain symptoms. The treatment should involve a personalized approach combining antithrombotic therapy, endovascular intervention, and styloidectomy to reduce the risk of stroke recurrence.