Traenka, Christopher
Mayo Clinic
Department of Rehabilitation and Neurology, University Department of Geriatric Medicine Felix Platter, Department of Clinical Research, University of Basel, Switzerland (J.E.K., C.T., S.T.E.).
Citations 2
Recurrent Cervical Artery Dissection Prevalence and Predictors: A Secondary Analysis of the STOP-CAD Study
Marto, João Pedro, Shu, Liqi , Wu, Eileen , Mendel, Daniel M., Heldner, Mirjam R. , Kaufmann, Josefin E. , Leker, Ronen R., Zedde, Marialuisa, Nehme, Ahmad , Muppa, Jayachandra , Sousa, Diana Aguiar de, Sousa, João André, Fonseca, Ana Catarina , Nzwalo, Hipólito , Romoli, Michele, Omran, Setareh Salehi , Keser, Z, Kam, Wayneho , Zubair, Adeel , Velez, Faddi G. Saleh, Elangovan, Cheran, Krishnaiah, Balaji , Metanis, Issa, Siegler, James E., Rothstein, Aaron, Khazaal, Ossama , Antonenko, Kateryna, Lester, Evan, Crandall, Ross , Rosa, Sara, Soares, Mafalda Delgado, Bakradze, Ekaterina, Ghannam, Malik , Elnazeir, Marwa , Klein, Piers, Traenka, Christopher , Henninger, Nils, Nguyen, Thanh N., Yaghi, Shadi, Zedde, Marialuisa , Henninger, Nils , Marto, João Pedro , Mandel, Daniel , Sousa, Diana Aguiar de , Soares, Mafalda , Marto, João Pedro , Wu, Eileen , Mandel, Daniel M , Leker, Ronen R , Zedde, Marialuisa , Aguiar de Sousa, Diana , Sousa, Joao Andre , Romoli, Michele , Salehi Omran, Setareh , Keser, Zafer , Bavarsad Shahripour, Reza , Kam, Wayneho , Zubair, Adeel , Saleh Velez, Faddi , Elangovan, Cheran , Krishnaiah, Balaji , Metanis, Issa , Pascarella, Rosario , Siegler, James E , Rothstein, Aaron , Khazaal, Ossama , Antonenko, Kateryna , Simpkins, Alexis N , Crandall, Ross , Rosa, Sara , Soares, Mafalda , Bakradze, Ekaterina , Willey, Joshua , Ghannam, Malik , Samaniego, Edgar A , Elnazeir, Marwa , Klein, Piers , Traenka, Christopher , Henninger, Nils , Nguyen, Thanh N , Engelter, Stefan T , Yaghi, Shadi , Muppa, Jayachandra , Heldner, Mirjam R , Kaufman, Josefin E , Fonseca, Ana Catarina , Nzwalo, Hipolito , Nehme, Ahmad , Keser, Zafer , Shahripour, Reza Bavarsad , Velez, Faddi G. Saleh , Elangovan, Cheran , Metanis, Issa , Pascarella, Rosario , Siegler, James E. , Rothstein, Aaron , Simpkins, Alexis N. , Bakradze, Ekaterina , Klein, Piers , Nguyen, Thanh N. , Engelter, Stefan T. , Yaghi, Shadi
Stroke | January 12, 2026 | Volume: 57 | Issue: 4 | Pages: 876-882
BACKGROUND: Patients with cervical artery dissection (CeAD) may experience a recurrent dissection, but its frequency, risk factors, and clinical implications are not well defined. We aimed to determine the risk, associated factors, and clinical impact of recurrent CeAD. METHODS: The STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection) was a multicenter international retrospective observational study of patients with CeAD treated between January 2015 and June 2022. Recurrent dissection was defined as a CeAD occurring at least 7 days after the diagnosis of the index event that affects a different artery or a different segment of the same artery. Patients were followed from day 7 up to 2 years. The absolute risk of recurrent CeAD over time was calculated using Kaplan-Meier survival estimates. Multivariable logistic and Cox regression models were used to assess predictors of CeAD recurrence. RESULTS: Of the 4023 patients included in STOP-CAD, 3836 (median age 46 years, 45% women) were eligible for this analysis. During a median (interquartile range) follow-up of 295 (97–720) days, 88 (2.29%) patients had a CeAD recurrence. Median time-to-recurrent CeAD was 53 (interquartile range, 18–157) days. The estimated risk of recurrent CeAD at 2 years was 3.22% (95% CI, 2.59%–4.00%). In multivariable analyses, younger age (adjusted odds ratios, 0.98 [95% CI, 0.96–0.99]), migraine (adjusted odds ratio, 1.88 [95% CI, 1.14–3.07]), and fibromuscular dysplasia (adjusted odds ratio, 2.90 [95% CI, 1.66–5.06]) were associated with CeAD recurrence, while presenting with an ischemic stroke was associated with a lower likelihood of recurrence (adjusted odds ratio, 0.47 [95% CI, 0.29–0.75]). These associations with CeAD recurrence over time were confirmed by Cox regression analyses. Among the 88 patients with recurrent CeAD, only 5 had accompanying ischemic events (3 strokes, 2 transient ischemic attacks). CONCLUSIONS: In this retrospective study, recurrent CeAD was uncommon, approximately half of the events were diagnosed within the first 2 months of the index event, and recurrent events rarely caused new ischemic events. Younger age, migraine, absence of ischemic stroke at presentation, and signs of fibromuscular dysplasia may help identify high-risk patients.
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. Saleh , Havenon, Adam de , Ranasinghe, Tamra , Siegler, James E. , Sharma, Richa , Marto, João Pedro , Klein, Piers , Nguyen, Thanh N. , Kim, Young Dae , Elangovan, Cheran , Alvarado‐Bolaños, Alonso , Martínez-Marino, Manuel , Ali, Farman, Morsi, Rami Z. , Simpkins, Alexis N. , Gomez, Roberto, Sen, Shayak, Kala, Narendra , Stretz, Christoph , Goldstein, Eric , Yaghi, Shadi
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.