Citations 2
Abstract A132: Young Adults with Cervical Artery Dissection have a Distinct Clinical Phenotype: A Post-Hoc Analysis of the STOP-CAD Study
Omran, Setareh Salehi , Shu, Liqi , Yaghi, Shadi, Sidebottom, Christian, Crandall, Ross , Lester, Evan, Lee, Conner, Henninger, Nils, Antonenko, Kateryna, Khan, Muhib, Mallick, Dania, Rothstein, Aaron, Khazaal, Ossama , Engelter, Stefan T, Traenka, Christopher , Gandhi, Preet , Metanis, Issa, Leker, Ronen, Guo, Xiaofan, Ghannam, Malik, AlMajali, Mohammad, Samaniego, Edgar, Fonseca, Ana, Cruz, Diana, Romoli, Michele, Keser, Zafer, Zedde, Marialuisa, Bakradze, Ekaterina, Velez, Faddi Saleh, Penckofer, Mary , Zubair, Adeel , Marto, Joao Pedro, Klein, Piers, Nguyen, Thanh N., Khasiyev, Farid, Elnazeir, Marwa , Krishnaiah, Balaji , Elangovan, Cheran, Henninger, Nils , Henninger, Nils , Yaghi, Shadi , Muppa, Jayachandra , Gunduz, Muhammed Enes , Heldner, Mirjam R. , Antonenko, Kateryna , Nehme, Ahmad , Khan, Muhib , Rothstein, Aaron , Kaufmann, Josefin E. , Engelter, Stefan T. , Metanis, Issa , Leker, Ronen R , von Rennenberg, Regina , Shahripour, Reza Bavarsad , Ghannam, Malik , Cruz, Diana , Romoli, Michele , Keser, Zafer , Zedde, Marialuisa , Grory, Brian Mac , Bakradze, Ekaterina , Velez, Faddi G. Saleh , Siegler, James E. , Willey, Joshua , Marto, João Pedro , Klein, Piers , Nguyen, Thanh N. , Simpkins, Alexis N. , Elangovan, Cheran
Stroke | January 29, 2026 | Volume: 57 | Issue: Suppl_1 | Pages: No page available
Background and Objectives: Cervical artery dissection (CeAD) is a common cause of ischemic stroke in young adults. We aim to identify age-based differences in clinical presentation, imaging findings, and outcomes after CeAD. Methods: This was a sub-study using the STOP-CAD registry, a multicenter cross-sectional international retrospective study of patients diagnosed with CeAD and treated with an antithrombotic from January 1, 2015 to December 31, 2021. Baseline clinical and imaging characteristics were compared between younger and older adults with CeAD (≤45 versus >45 years of age) using multivariable logistic regression. We chose this age cut off due to its frequent usage in stroke in the young literature. Multiple logistic regression models were used to determine association between young age and outcomes after CeAD (ischemic stroke at 180 days, excellent functional outcome with modified Rankin Scale of 0-1 at 90 days, and mortality) after adjusting for sex, vascular risk factors, CeAD characteristics, and NIHSS on presentation. Results: Among 4023 CeAD patients included in the study, 1901 (47.3%) were ≤45 years of age. Patients were followed for a median of 307 days (IQR 102-831). Young adults with CeAD were more likely to be women (Odds Ratio [OR], 2.4; 95% CI, 2.1-2.9; p<0.001), of Hispanic ethnicity (OR, 1.8; 95% CI 1.3-2.5; p<0.001), have a history of migraines (OR, 1.6; 95% CI, 1.3-2.0; p<0.001) and recent neck trauma (OR, 1.6; 95% CI, 1.3-1.9; p<0.001) while having fewer traditional vascular risk factors. Young adults with CeAD had higher odds of a non-ischemic presentation (OR, 1.3; 95% CI, 1.1-1.5; p=0.013), vertebral artery dissection (OR 2.5; 95% CI, 2.2-3.0; p<0.001), and multivessel involvement (OR 1.5; 95% CI, 1.1-1.9; p=0.004). In adjusted analysis, younger age was not associated with an increased risk of recurrent ischemic stroke (adjusted Hazard Ratio [HR], 0.48; 95% CI 0.2-1.2; p=0.119). Younger age was associated with significantly greater odds of excellent functional outcome at 90 days (aOR, 1.48; 1.20-1.84, p<0.001) and lower risk of death at follow up (aHR, 0.37; 95% CI, 0.17-0.81; p=0.012) after CeAD. Conclusion: In a large international cohort, young adults with CeAD had a distinct clinical phenotype with higher odds of non-ischemic presentation, vertebral artery dissection, and multivessel involvement while having fewer traditional vascular risk factors. Young adults had a decreased odds of disability and mortality after CeAD.
Effects of Intradural Extension of Extracranial Cervical Artery Dissection on Outcomes: A Secondary Analysis From the STOP ‐ CAD Study
Metanis, Issa , Shu, Liqi , Akpokiere, Favour , Jubran, Hamza , Mandel, Daniel , Nolte, Christian H. , Grory, Brian Mac , Frontera, Jennifer , Khan, Muhib, Rothstein, Aaron , Marto, João Pedro, Zedde, Marialuisa, Poppe, AY, Jubeh, Tamer , AlMajali, Mohammad, Shalabi, Fatma , Henninger, Nils , Rosa, Sara , Khazaal, Ossama , Kaufman, Josefine E., Traenka, Christopher , Bakradze, Ekaterina , Zubair, Adeel , Sousa, João André, Mantovani, Gabriel Paulo , Omran, Setareh Salehi , Elnazeir, Marwa , Sousa, Diana Aguiar de , Yaghi, Shadi, Sousa, João André , Mandel, Daniel M , Frontera, Jennifer , Henninger, Nils , Heldner, Mirjam R , Kaufman, Josefin E , Bakradze, Ekaterina , Zubair, Adeel , Ranasinghe, Tamra , Sousa, Joao Andre , Salehi Omran, Setareh , Elnazeir, Marwa , Yaghi, Shadi , Keser, Zafer , Aguiar de Sousa, Diana , Rosa, Sara , Metanis, Issa , Nolte, Christian H , Mac Grory, Brian , Siegler, James E. , Engelter, Stefan T. , Khan, Muhib , Schwartzmann, Yoel , Zedde, Marialuisa , Keser, Zafer , Antonenko, Kateryna , Heldner, Mirjam R. , Kaufmann, Josefin E. , Ranasinghe, Tamra , Simpkins, Alexis N. , Sargento‐Freitas, João , Yaghi, Shadi , Leker, Ronen R
Annals of Neurology | January 8, 2026 | Volume: 99 | Issue: 5 | Pages: 1189-1197
Objective Cervical artery dissection (CeAD) may be limited to the extracranial extradural space or extend to the intradural space. Intradural extension can potentially increase the risk of stroke and subarachnoid hemorrhage. However, the factors associated with intradural extension and its impact on clinical outcome remain unclear. Methods This was a secondary analysis of the STOP‐CAD observational, multi‐center study. Patients with CeAD and intradural extension (CeADid) were compared with those with pure CeAD extradural dissections (CeADed) using multiple regression analyses. Results Of 4,023 patients with CeAD, 534 (13.3%) had CeADid. In comparison to patients with CeADed, those with CeADid more often had clinical overt stroke or transient ischemic attack (TIA) at presentation, acute infarcts on imaging, a vertebral artery affected, and severe stenosis of the involved vessel ( p < 0.001 for all). In contrast, carotid involvement and complete occlusions were more frequent in patients with CeADed ( p < 0.001 for both). CeADid was associated with a shift in the distribution of scores on the modified Rankin Scale (mRS) toward worse functional outcome (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.62–0.92) but the odds for favorable outcomes (mRS = 0–2) did not differ between the groups after appropriate adjustments on multivariate analysis. CeADid was independently associated with higher mortality at 180 days on multivariate analysis (adjusted OR = 2.84, 95% CI = 1.50–5.38). Interpretation CeADid is associated with more severe clinical presentation, a shift toward less favorable outcomes, and higher mortality rates. These findings suggest that CeADid may represent a high‐risk type of CeAD. ANN NEUROL 2026;99:1189–1197