/ Neurology

Artery occlusion independently predicts unfavorable outcome in cervical artery dissection

Christopher Traenka, MD, Caspar Grond-Ginsbach, PhD, Barbara Goeggel Simonetti, MD, Tiina M. Metso, MD, PhD, St´ephanie Debette, MD, PhD, Alessandro Pezzini, MD, Manja Kloss, MD, Jennifer J. Majersik, MD, MS, Andrew M. Southerland, MD, MSc, Didier Leys, MD, PhD, Ralf Baumgartner, MD, Valeria Caso, MD, PhD, Yannick B´ejot, MD, PhD, Gian Marco De Marchis, MD, MSc, Urs Fischer, MD, Alexandros Polymeris, MD, Hakan Sarikaya, MD, Vincent Thijs, MD, PhD, Bradford B. Worrall, MD, MSc, Anna Bersano, MD, PhD, Tobias Brandt, MD, Henrik Gensicke, MD, Leo H. Bonati, MD, Emmanuel Touze´e, MD, PhD, Juan J. Martin, MD, Hugues Chabriat, MD, PhD, Turgut Tatlisumak, MD, PhD, Marcel Arnold, MD, Stefan T. Engelter, MD, and Philippe Lyrer, MD, for the CADISP-Plus Study Group

Neurology 2020, 94:1-11.
First published November 22, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008654

The research team of the Stroke Center Basel publishes a pioneering international study in the renowned journal "Neurology" (impact factor 8,689)

Cervical arterial dissections (CeAD) are among the most common causes of stroke in younger adults. The main characteristic of CeAD is a - usually spontaneously developing - wall hematoma, which can lead to an occlusion of the affected cervical artery and thus to an ischemic stroke. Such an occlusion is found in the acute phase in about 1/3 of all CeAD patients and can be quickly detected within the scope of acute diagnostics - by means of CT or MR angiography, but also duplex sonography. To what extent the presence of an occlusion of the affected artery has a prognostic significance for the outcome of the patients has been unclear so far.

In a study conducted by Christopher Traenka (first author, Neurology and Stroke Center USB), Stefan Engelter (last author; Neurology USB and Neurorehabilitation FELIX PLATTER), and Philippe Lyrer (last author, Head of Stroke Center USB), in a register-based study coordinated by the international research consortium CADISP-PLUS (Cervical Artery Dissection and Ischemic Stroke Patients-PLUS), data from 2148 CeAD patients could now be systematically examined with regard to the significance of vascular occlusion. (co-authors of the Stroke Center Basel Leo Bonati, Gian Marco De Marchis, Henrik Gensicke, Alexandros Polymeris)

The evaluation shows that the presence of vascular occlusion increases the probability of a worse functional outcome independent of other factors (e.g. initial severity of stroke, occurrence of recurrent ischemic events). Patients with vascular occlusion also showed a higher rate of strokes within the follow-up period of up to 6 months.This study provides important evidence that vascular findings in CeAD are of great prognostic importance and should therefore be carefully recorded and monitored in the follow-up period when CeAD occurs. Although the effectiveness of endovascular acute treatment in this specific group of stroke patients has not yet been proven, the results of this study support the approach of reopening the affected vessel in the acute situation.

The Stroke Center Basel has taken a leading role internationally in both the clinical care of CeAD patients and in research on CeAD. This is documented once again by this work.