Citations 2
Abstract WP047: Incidental Cerebral Aneurysms in Patients with Cervical Artery Dissection
Stretz, Christoph, Shu, Liqi , Mandel, Daniel M, Samaniego, Edgar A., Nguyen, Thanh N., Liebeskind, D, Guerrero, Christopher Leon, Arnold, Marcel, Omran, Setareh Salehi , Sousa, João André, Khan, Muhib, Rothstein, Aaron, Engelter, Stefan T, Sousa, Diana Aguiar de, FIELD, Thalia, Leker, Ronen, Dantu, Vishnu , Choi, Richard , Ghannam, Malik, Poppe, Alexandre, Romoli, Michele, Keser, Zafer, Frontera, Jennifer, Zedde, Marialuisa, MacGrory, Brian, Kasab, Sami Al, Bakradze, Ekaterina, Rodrigo-Gisbert, Marc, Velez, Faddi Saleh, Vishnu, Venugopalan, Yaddanapudi, Sridhara , Zubair, Adeel , Marto, Joao Pedro, Klein, Piers, Martins, Sheila, Krishnaiah, Balaji , Elangovan, Cheran, Qureshi, Abid, Mannino, Marina, Sarvath, Mohammed, Kass-Hout, T, Sen, Shayak, Elnazeir, Marwa , Furie, Karen, Yaghi, Shadi, Field, Thalia S. , Sousa, Diana Aguiar de , Field, Thalia S , Aguiar de Sousa, Diana , Stretz, Christoph , Samaniego, Edgar A , Leon Guerrero, Christopher R , Heldner, Mirjam R. , Arnold, Marcel , Nehme, Ahmad , Khan, Muhib , Rothstein, Aaron , Engelter, Stefan T. , Leker, Ronen R , Ghannam, Malik , Fonseca, Ana Catarina , Romoli, Michele , Keser, Zafer , Zedde, Marialuisa , Kasab, Sami Al , Bakradze, Ekaterina , Rodrigo‐Gisbert, Marc , Velez, Faddi G. Saleh , Vishnu, Venugopalan, Marto, João Pedro , Klein, Piers , Elangovan, Cheran , Mannino, Marina , VASILOPOULOU, SOFIA, Kass‐Hout, Tareq , Khan, Fahad
Stroke | January 29, 2026 | Volume: 57 | Issue: Suppl_1 | Pages: No page available
Background: Patients with cervical artery dissection (CAD) have a higher prevalence of cerebral aneurysms, likely due to underlying vasculopathies. Understanding risk factors and outcomes in this population may inform screening and management strategies. Methods: We conducted a post-hoc analysis of the STOP-CAD study, a multicenter international registry of patients with non-major trauma-related CAD across 63 centers. Cerebral aneurysms were identified based on medical history and intracranial vascular imaging obtained for dissection diagnosis. We compared demographic, clinical, laboratory, and imaging characteristics between patients with and without aneurysms. Variables with p<0.05 in univariate analysis were entered into a multivariable binary logistic regression to identify independent predictors. Clinical outcomes including ischemic stroke and symptomatic intracranial hemorrhage at follow-up were compared between both groups. Results: Out of 4023 patients included in the STOP-CAD study, 116 (2.9%) had at least one incidental cerebral aneurysm. In adjusted binary logistic regression, patients with cerebral aneurysm were more likely to have a history of migraine (aOR 1.78 95% CI 1.15-2.75, p=0.009), history of hypertension (aOR 1.65 95% CI 1.12-2.43, p = 0.010), known connective tissue disorder (aOR 3.47 95% CI 1.71-7.03), history of dissection (aOR 2.63 95% CI 1.31-5.28, p = 0.007), and a dissecting aneurysm at the site of the dissection (aOR 1.94 95% CI 1.25-3.01, p = 0.003). At follow-up, the presence of a cerebral aneurysm was not associated with ischemic stroke (7.8% vs. 5.6% p>0.1), but with a trend towards increased odds of symptomatic intracranial hemorrhage (3.4% vs. 1.2%, p = 0.062). Conclusions: Patients with CAD and concurrent incidental cerebral aneurysm were more likely to have a history of migraine headaches and markers of underlying vasculopathy and had a non-significantly increased risk of intracranial hemorrhage at follow-up. Further studies are needed to identify best practices for surveillance and risk stratification in this subgroup.
Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study
Yaghi, Shadi, Shu, Liqi , Mandel, Daniel , Henninger, Nils , Muppa, Jayachandra , Affan, Muhammad , Lodhi, Omair ul haq , Heldner, Mirjam R. , Seiffge, David , Omran, Setareh Salehi , Crandall, Ross , Lester, Evan, Mena, Diego López, Araúz, Antonio , Nehme, Ahmad , Boulanger, Marion , Sousa, João André , Sargento‐Freitas, João , Barata, Vasco , Castro‐Chaves, Paulo , Brito, Maria Teresa , Khan, Muhib , Mallick, Dania, Rothstein, Aaron , Khazaal, Ossama , Kaufmann, Josefin E. , Engelter, Stefan T. , Traenka, Christopher , Sousa, Diana Aguiar de , Soares, Mafalda , Rosa, Sara , Zhou, Lily , Gandhi, Preet , Field, Thalia S. , Mancini, Steven, Metanis, Issa , Pan, Kelly , Dantu, Vishnu , Baumgartner, Karl , Nolte, Christian H. , Choi, Richard , MacDonald, Jason , Shahripour, Reza Bavarsad , Ghannam, Malik , Almajali, Mohammad , Sanchez, Sebastian , Zine-Eddine, Fayçal, Poppe, Alexandre Y. , Fonseca, Ana Catarina , Baptista, Maria Fortuna , Cruz, Diana , Marco, Giovanna De , Griffin, Kim, Kuohn, Lindsey , Frontera, Jennifer , Amar, Jordan , Giles, James , Grisendi, Ilaria , Nzwalo, Hipólito , Liebeskind, David S. , Molaie, Amir , Cavalier, Annie, Kam, Wayneho , Grory, Brian Mac , Kasab, Sami Al , Eltatawy, Ali , Chervak, Lina , Chulluncuy‐Rivas, Roberto, Aziz, Yasmin , Bakradze, Ekaterina , Tran, Thanh Lam , Rodrigo‐Gisbert, Marc , Velez, Faddi Saleh, Gracia, Jorge Ortiz, Mudassani, Varsha, Vishnu, Venugopalan Y. , Yaddanapudi, Sridhara , Adams, L, Browngoehl, Abigail, Ranasinghe, Tamra , Dunston, Randy, Lynch, Zachary, Penckofer, Mary , Mayer, Silvia, Zubair, Adeel , Cheng, Yee Kuang, Ferreira, Vítor Mendes , Asad, Syed Daniyal , Sarwat, Zoha, Balabhadra, Anvesh , Patel, Shivam , Secchi, Thaís , Mantovani, Gabriel, Kim, Young Dae , Krishnaiah, Balaji , Elangovan, Cheran , Lingam, Sivani, Quereshi, Abid, Alvarado, Alonso, Khasiyev, Farid , Linares, Guillermo , Mannino, Marina , Terruso, Valeria, Vassilopoulou, Sofia , Tentolouris, Vasilis, Martínez-Marino, Manuel , Wall, Victor Carrasco , Indraswari, Fransisca , Jamal, Sleiman El , Alvi, Muhammad , Sarvath, Mohammed, Kass‐Hout, Tareq , Shi, Feina , Zhang, Jinhua , Said, Jamil , Sen, Shayak, Ghani, Mohammad R , Elnazeir, Marwa , Xiao, Han , Kala, Narendra , Khan, Farhan , Mohammadzadeh, Nahid , Furie, Karen L. , Alvarado‐Bolaños, Alonso , Tentolouris-Piperas, Vasileios , Leon Guerrero, Christopher R , Henninger, Nils , Muppa, Jayachandra , Heldner, Mirjam R , Liebeskind, David S. , Field, Thalia S , Keser, Zafer , Aziz, Yasmin , Mandel, Daniel M , Seiffge, David , Arauz, Antonio , Sousa, Joao Andre , Sargento-Freitas, Joao , Castro-Chaves, Paulo , Kaufman, Josefin E , Engelter, Stefan T , Aguiar de Sousa, Diana , Soares, Mafalda , Rosa, Sara , Metanis, Issa , Nolte, Christian H , Bavarsad Shahripour, Reza , Almajali, Mohammad , Fonseca, Ana Catarina , Kuohn, Lindsey , Frontera, Jennifer , Giles, James , Nzwalo, Hipolito , Mac Grory, Brian , Eltatawy, Ali , Rodrigo Gisbert, Marc , Vishnu, Venugopalan Y , Ranasinghe, Tamra , Mendes Ferreira, Vítor , Kim, Young Dae , Elangovan, Cheran , Alvarado-Bolanos, Alonso , Khasiyev, Farid , Tentolouris-Piperas, Vasileios , Martinez Marino, Manuel , Ghani, Mohammad , Xiao, Han , Khan, Farhan , Nehme, Ahmad , Yaghi, Shadi , Antonenko, Kateryna , Arnold, Marcel , Touzé, Emmanuel , Leker, Ronen R , Burton, Tina , von Rennenberg, Regina , MacDonald, Jason, Guo, Xiaofan , Samaniego, Edgar A , Rioux, Bastien , Cruz, Diana , Romoli, Michele , Longoni, Marco , Keser, Zafer , Zedde, Marialuisa , Pascarella, Rosario , Anadani, Mohammad , Kicielinski, Kimberly , Requena, Manuel , Velez, Faddi G. Saleh , Havenon, Adam de , Siegler, James E. , Willey, Joshua , Sharma, Richa , Marto, João Pedro , Klein, Piers , Nguyen, Thanh N. , Martins, Sheila , Fridman, Sebastian , Liu, Shilin , Ali, Farman, Morsi, Rami Z. , Sokhi, Dilraj , Simpkins, Alexis N. , Gomez, Roberto, Sen, Shayak, Stretz, Christoph , Goldstein, Eric
Stroke | June 4, 2025 | Volume: 55 | Issue: 4 | Pages: 908-918
BACKGROUND: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation. METHODS: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma. The exposure was antithrombotic treatment type (anticoagulation versus antiplatelets), and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with inverse probability of treatment weighting to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an as-treated crossover approach and only included outcomes occurring with the above treatments. RESULTS: The study included 3636 patients (402 [11.1%] received exclusively anticoagulation and 2453 [67.5%] received exclusively antiplatelets). By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with inverse probability of treatment weighting, compared with antiplatelet therapy, anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted hazard ratio [HR], 0.71 [95% CI, 0.45–1.12]; P =0.145) and by day 180 (adjusted HR, 0.80 [95% CI, 0.28–2.24]; P =0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR, 1.39 [95% CI, 0.35–5.45]; P =0.637) but was by day 180 (adjusted HR, 5.56 [95% CI, 1.53–20.13]; P =0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR, 0.40 [95% CI, 0.18–0.88]; P interaction =0.009). CONCLUSIONS: Our study does not rule out the benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.