Медицинская библиотека · Stroke · 2025

Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection.

Mandel Daniel M, Shu Liqi, Chang Christopher, Jack Naomi, Leon Guerrero Christopher R, Henninger Nils, Muppa Jayachandra, Affan Muhammad, Ul Haq Lodhi Omair, Heldner Mirjam R, Antonenko Kateryna, Seiffge David, Arnold Marcel, Salehi Omran Setareh, Crandall Ross, Lester Evan, Lopez Mena Diego, Arauz Antonio, Nehme Ahmad, Boulanger Marion, Touzé Emmanuel, Sousa Joao Andre, Sargento-Freitas Joao, Barata Vasco, Castro-Chaves Paulo, Brito Maria Teresa, Khan Muhib, Mallick Dania, Rothstein Aaron, Khazaal Ossama, Kaufman Josefin E, Engelter Stefan T, Traenka Christopher, Aguiar de Sousa Diana, Soares Mafalda, Rosa Sara, Zhou Lily W, Gandhi Preet, Field Thalia S, Mancini Steven, Metanis Issa, Leker Ronen R, Pan Kelly, Dantu Vishnu, Baumgartner Karl, Burton Tina, von Rennenberg Regina, Nolte Christian H, Choi Richard, MacDonald Jason, Bavarsad Shahripour Reza, Guo Xiaofan, Ghannam Malik, Almajali Mohammad, Samaniego Edgar A, Sanchez Sebastian, Rioux Bastien, Zine-Eddine Faycal, Poppe Alexandre, Fonseca Ana Catarina, Fortuna Baptista Maria, Cruz Diana, Romoli Michele, De Marco Giovanna, Longoni Marco, Keser Zafer, Griffin Kim, Kuohn Lindsey, Frontera Jennifer, Amar Jordan, Giles James, Zedde Marialuisa, Pascarella Rosario, Grisendi Ilaria, Nzwalo Hipolito, Liebeskind David S, Molaie Amir, Cavalier Annie, Kam Wayneho, Mac Grory Brian, Al Kasab Sami, Anadani Mohammad, Kicielinski Kimberly, Eltatawy Ali, Chervak Lina, Chulluncuy Rivas Roberto, Aziz Yasmin, Bakradze Ekaterina, Tran Thanh Lam, Rodrigo Gisbert Marc, Requena Manuel, Saleh Velez Faddi, Garcia Jorge Ortiz, Muddasani Varsha, de Havenon Adam, Vishnu Venugopalan Y, Yaddanapudi Sridhara, Adams Latasha, Browngoehl Abigail, Ranasinghe Tamra, Dunston Randy, Lynch Zachary, Penckofer Mary, Siegler James E, Mayer Silvia, Willey Joshua, Zubair Adeel, Cheng Yee Kuang, Sharma Richa, Marto João Pedro, Mendes Ferreira Vítor, Klein Piers, Nguyen Thanh N, Asad Syed Daniyal, Sarwat Zoha, Balabhadra Anvesh, Patel Shivam, Secchi Thais, Martins Sheila, Mantovani Gabriel, Kim Young Dae, Krishnaiah Balaji, Elangovan Cheran, Lingam Sivani, Qureshi Abid Y, Fridman Sebastian, Alvarado-Bolanos Alonso, Khasiyev Farid, Linares Guillermo, Mannino Marina, Terruso Valeria, Vassilopoulou Sofia, Tentolouris-Piperas Vasileios, Martinez Marino Manuel, Carrasco Wall Victor, Indraswari Fransisca, El Jamal Sleiman, Liu Shilin, Alvi Muhammad, Ali Farman, Sarvath Mohammed, Morsi Rami Z, Kass-Hout Tareq, Shi Feina, Zhang Jinhua, Sokhi Dilraj, Said Jamil, Mongare Newnex, Simpkins Alexis N, Gomez Roberto, Sen Shayak, Ghani Mohammad, Elnazeir Marwa, Xiao Han, Kala Narendra, Khan Farhan, Stretz Christoph, Mohammadzadeh Nahid, Goldstein Eric, Furie Karen, Yaghi Shadi

СтатьяНаблюдательное исследованиеМногоцентровое исследованиеПеревод в очереди

Аннотация

BACKGROUND

Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals.

METHODS

This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022. The primary outcome was subsequent ischemic stroke by day 180 after diagnosis. Clinical and imaging variables were compared between those with versus without subsequent ischemic stroke. Significant factors associated with subsequent stroke risk were identified using stepwise Cox regression. Associations between subsequent ischemic stroke risk and antithrombotic therapy type (anticoagulation versus antiplatelets) among patients with identified risk factors were explored using adjusted Cox regression.

RESULTS

In all, 4023 patients (mean age was 47.4 years; 44.5% were women) were included. By day 180, subsequent ischemic stroke occurred in 5.3% of the cohort. In adjusted Cox regression, factors associated with increased risk of subsequent ischemic stroke were prior history of ischemic stroke (adjusted hazard ratio [aHR], 7.31 [95% CI, 1.61-33.13]; P=0.010), presentation within 7 days from first symptoms (aHR, 3.04 [95% CI, 1.04-8.91]; P=0.043), infarct on baseline imaging (aHR, 9.85 [95% CI, 3.65-26.58]; P<0.001), and occlusive dissection (aHR, 2.34 [95% CI, 1.03-5.34]; P=0.043). Only patients with occlusive dissection demonstrated a reduced risk of subsequent ischemic stroke when treated with anticoagulation versus antiplatelets (aHR, 0.36 [95% CI, 0.16-0.80]; P=0.01).

CONCLUSIONS

In this post hoc analysis of the STOP-CAD study, several factors associated with subsequent ischemic stroke were identified among patients with CAD. Furthermore, we identified a potential benefit of anticoagulation in patients with CAD with occlusive dissection. These findings require validation by meta-analyses of prior studies to formulate optimal treatment strategies for specific high-risk CAD subgroups.

Для цитирования: Mandel Daniel M, Shu Liqi, Chang Christopher, Jack Naomi, Leon Guerrero Christopher R, Henninger Nils, Muppa Jayachandra, Affan Muhammad, Ul Haq Lodhi Omair, Heldner Mirjam R, Antonenko Kateryna, Seiffge David, Arnold Marcel, Salehi Omran Setareh, Crandall Ross, Lester Evan, Lopez Mena Diego, Arauz Antonio, Nehme Ahmad, Boulanger Marion, Touzé Emmanuel, Sousa Joao Andre, Sargento-Freitas Joao, Barata Vasco, Castro-Chaves Paulo, Brito Maria Teresa, Khan Muhib, Mallick Dania, Rothstein Aaron, Khazaal Ossama, Kaufman Josefin E, Engelter Stefan T, Traenka Christopher, Aguiar de Sousa Diana, Soares Mafalda, Rosa Sara, Zhou Lily W, Gandhi Preet, Field Thalia S, Mancini Steven, Metanis Issa, Leker Ronen R, Pan Kelly, Dantu Vishnu, Baumgartner Karl, Burton Tina, von Rennenberg Regina, Nolte Christian H, Choi Richard, MacDonald Jason, Bavarsad Shahripour Reza, Guo Xiaofan, Ghannam Malik, Almajali Mohammad, Samaniego Edgar A, Sanchez Sebastian, Rioux Bastien, Zine-Eddine Faycal, Poppe Alexandre, Fonseca Ana Catarina, Fortuna Baptista Maria, Cruz Diana, Romoli Michele, De Marco Giovanna, Longoni Marco, Keser Zafer, Griffin Kim, Kuohn Lindsey, Frontera Jennifer, Amar Jordan, Giles James, Zedde Marialuisa, Pascarella Rosario, Grisendi Ilaria, Nzwalo Hipolito, Liebeskind David S, Molaie Amir, Cavalier Annie, Kam Wayneho, Mac Grory Brian, Al Kasab Sami, Anadani Mohammad, Kicielinski Kimberly, Eltatawy Ali, Chervak Lina, Chulluncuy Rivas Roberto, Aziz Yasmin, Bakradze Ekaterina, Tran Thanh Lam, Rodrigo Gisbert Marc, Requena Manuel, Saleh Velez Faddi, Garcia Jorge Ortiz, Muddasani Varsha, de Havenon Adam, Vishnu Venugopalan Y, Yaddanapudi Sridhara, Adams Latasha, Browngoehl Abigail, Ranasinghe Tamra, Dunston Randy, Lynch Zachary, Penckofer Mary, Siegler James E, Mayer Silvia, Willey Joshua, Zubair Adeel, Cheng Yee Kuang, Sharma Richa, Marto João Pedro, Mendes Ferreira Vítor, Klein Piers, Nguyen Thanh N, Asad Syed Daniyal, Sarwat Zoha, Balabhadra Anvesh, Patel Shivam, Secchi Thais, Martins Sheila, Mantovani Gabriel, Kim Young Dae, Krishnaiah Balaji, Elangovan Cheran, Lingam Sivani, Qureshi Abid Y, Fridman Sebastian, Alvarado-Bolanos Alonso, Khasiyev Farid, Linares Guillermo, Mannino Marina, Terruso Valeria, Vassilopoulou Sofia, Tentolouris-Piperas Vasileios, Martinez Marino Manuel, Carrasco Wall Victor, Indraswari Fransisca, El Jamal Sleiman, Liu Shilin, Alvi Muhammad, Ali Farman, Sarvath Mohammed, Morsi Rami Z, Kass-Hout Tareq, Shi Feina, Zhang Jinhua, Sokhi Dilraj, Said Jamil, Mongare Newnex, Simpkins Alexis N, Gomez Roberto, Sen Shayak, Ghani Mohammad, Elnazeir Marwa, Xiao Han, Kala Narendra, Khan Farhan, Stretz Christoph, Mohammadzadeh Nahid, Goldstein Eric, Furie Karen, Yaghi Shadi. Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection.. Stroke. 2025. DOI: 10.1161/strokeaha.124.048215.

Предметные рубрики MeSH

Humans Female Male Middle Aged Retrospective Studies Ischemic Stroke Platelet Aggregation Inhibitors Adult Risk Factors Vertebral Artery Dissection Anticoagulants Recurrence Stroke Aged Carotid Artery, Internal, Dissection

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