Citations 12
Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection
Mandel, Daniel , Shu, Liqi , Chang, Christopher , JACK, N , Henninger, Nils , Muppa, Jayachandra , Affan, Muhammad , Lodhi, Omair ul haq , Heldner, Mirjam R. , Omran, Setareh Salehi , Crandall, Ross , Lester, Evan, Araúz, Antonio , Boulanger, Marion , Sousa, João André , Barata, Vasco , Castro‐Chaves, Paulo , Brito, Maria Teresa , Khan, Muhib , Mallick, Dania, Rothstein, Aaron , Khazaal, Ossama , Traenka, Christopher , Sousa, Diana Aguiar de , Soares, Mafalda , Rosa, Sara , Zhou, Lily , Gandhi, Preet , Field, Thalia S. , Mancini, Steven, Pan, Kelly , Dantu, Vishnu , Baumgartner, Karl , Nolte, Christian H. , Choi, Richard , Macdonald, J , 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 J. , Kuohn, Lindsey , Frontera, Jennifer , Amar, Jordan , Grisendi, Ilaria , Nzwalo, Hipólito , Liebeskind, David S. , Molaie, Amir , Cavalier, Annie, Kam, Wayneho , Grory, Brian Mac , Kasab, Sami Al , Eltatawy, Ali , Chervak, Lina , Rivas, Roberto Chulluncuy, Bakradze, Ekaterina , Tran, Thanh Lam , Ortiz-Garcia, Jorge , Muddasani, Varsha , Vishnu, Venugopalan Y. , Yaddanapudi, Sridhara , Adams, L, Browngoehl, Abigail, 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 Paulo , Krishnaiah, Balaji , Lingam, Sivani, Khasiyev, Farid , Linares, Guillermo , Mannino, Marina , Terruso, Valeria, Vassilopoulou, Sofia , Tentolouris-Piperas, Vasileios , Wall, Victor Carrasco , Indraswari, Fransisca , Jamal, Sleiman El , Liu, Shilin, Alvi, Muhammad , Sarvath, Mohammed, Kass‐Hout, Tareq , Shi, Feina , Zhang, Jinhua , Said, Jamil , Mongare, Newnex, Sen, Shayak, Ghani, Mohammad R , Elnazeir, Marwa , Xiao, Han , Khan, Farhan , Mohammadzadeh, Nahid , Furie, Karen L. , Mandel, Daniel M , Jack, Naomi , Leon Guerrero, Christopher R , Henninger, Nils , Muppa, Jayachandra , Heldner, Mirjam R , Antonenko, Kateryna , Seiffge, David , Arnold, Marcel , Salehi Omran, Setareh , Crandall, Ross , Lopez Mena, Diego , Arauz, Antonio , Boulanger, Marion , Touzé, Emmanuel , Sousa, Joao Andre , Sargento-Freitas, Joao , Barata, Vasco , Castro-Chaves, Paulo , Brito, Maria Teresa , Khan, Muhib , 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 , Metanis, Issa , Leker, Ronen R , 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 , Poppe, Alexandre , Fonseca, Ana Catarina , Fortuna Baptista, Maria , Cruz, Diana , Romoli, Michele , Longoni, Marco , Keser, Zafer , Kuohn, Lindsey , Frontera, Jennifer , Giles, James , Zedde, Marialuisa , Pascarella, Rosario , Grisendi, Ilaria , Nzwalo, Hipolito , Liebeskind, David S. , Molaie, Amir , Kam, Wayneho , Mac Grory, Brian , Al Kasab, Sami , Anadani, Mohammad , Kicielinski, Kimberly , Eltatawy, Ali , Chervak, Lina , Aziz, Yasmin , Bakradze, Ekaterina , Rodrigo Gisbert, Marc , Requena, Manuel , Saleh Velez, Faddi , Garcia, Jorge Ortiz , Muddasani, Varsha , de Havenon, Adam H , Vishnu, Venugopalan Y , Adams, Latasha , Ranasinghe, Tamra , 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 , Balabhadra, Anvesh , Martins, Sheila , Mantovani, Gabriel , Kim, Young Dae , Krishnaiah, Balaji , Elangovan, Cheran , 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 , Sarvath, Mohammed , Morsi, Rami Z , Kass-Hout, Tareq , Shi, Feina , Zhang, Jinhua , Sokhi, Dilraj , Simpkins, Alexis N , Ghani, Mohammad , Elnazeir, Marwa , Xiao, Han , Khan, Farhan , Stretz, Christoph , Goldstein, Eric D , Furie, Karen L , Yaghi, Shadi , Seiffge, David , Nehme, Ahmad , Sargento‐Freitas, João , Kaufmann, Josefin E. , Engelter, Stefan T. , Metanis, Issa , Shahripour, Reza Bavarsad , Guo, Xiaofan , Keser, Zafer , Giles, James , Zedde, Marialuisa , Pascarella, Rosario , Aziz, Yasmin , Rodrigo‐Gisbert, Marc , Requena, Manuel , Velez, Faddi G. 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Stroke | March 27, 2025 | Volume: 56 | Issue: 6 | Pages: 1413-1421
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.
Application of transcranial Doppler in the diagnosis and management of cervical artery dissection: Insights from a multicenter survey within the STOP‐CAD study
Guo, Xiaofan , Shifflett, Benjamin , Khan, Muhib , Rothstein, Aaron , Khazaal, Ossama , Elnazeir, Marwa , Hansra, Harjot, Meyer, Brett C. , Guo, Xiaofan , Sabayan, Behnam , Antonenko, Kateryna , Heldner, Mirjam R. , Romoli, Michele , Marto, João Pedro , Keser, Zafer , Meyer, Dawn , Shahripour, Reza Bavarsad
Clinical Neuroimaging | October 4, 2024 | Volume: 1 | Issue: 1-2 | Pages: No page available
AbstractBackgroundCervical artery dissection (CAD) is a common cause of ischemic stroke in young adults. Local blood clot formation and distal emboli are the key mechanisms for the development of stroke in patients with CAD. Microemboli distal to the dissection point can be detected as high‐intensity transient signals (HITS) using transcranial Doppler (TCD). Despite this unique capability, TCD is used inconsistently in the management of CAD. In this international survey, we aim to explore the frequency and potential barriers to TCD use in CAD.MethodThis study was an international electronic survey, based on the Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP‐CAD) study, aiming at evaluating the use of TCD in diagnosing and managing CAD patients. A comprehensive questionnaire was developed to gather insights into the current practices, perceptions, and potential barriers to the effective use of TCD in participating centers. The collected data was then analyzed.ResultsFifty‐eight medical centers with advanced stroke care capabilities from Europe and United States participated in this study. Half (29 out of 58) of the sites routinely perform TCD on CAD patients, particularly in the presence of carotid or vertebral artery stenosis, complete carotid occlusion, and early neurologic deterioration. The primary reason for participating institutions not performing TCD was because its results would not change their practice. The protocol for TCD monitoring and managing HITS‐positive CAD patients varied among centers but transitioning from antiplatelet to anticoagulant was the most common practice in this patient population.ConclusionHalf of the stroke centers in our survey routinely perform TCD monitoring for CAD patients. The detection of HITS in CAD patients is a warning sign for providers, which may prompt a change in secondary stroke prevention management. However, a standard protocol for performing TCD in CAD and treatment recommendations for HITS‐positive CAD are not currently available, which warrants further research.