Seby John, MD

Béjot Y, Aboa-Eboulé C, Debette S, Pezzini A, Tatlisumak T, Engelter S, et al. Characteristics and Outcomes of Patients With Multiple Cervical Artery Dissection. Stroke. 2013

Cervical artery dissection (CeAD) although rare in the general population is an important cause of stroke. This is especially the case in younger patients where CeAD is the leading cause of stroke in patients < 45 years. This paper comes from the CADISP (Cervical Artery Dissections and Ischemic Stroke Patients) multicenter international consortium that has the largest series of patients with CeAD. Béjot and colleagues compare the characteristics and short-term outcomes of patients with single versus multiple artery CeAD.

Out of 983 patients with CeAD, 15.2% had multi-vessel dissection. Multiple CeAD was more often associated with cervical pain at admission, a remote history of head or neck surgery, recent infection and cervical manipulation. Adjusted analysis showed that hypertension was significant associated with multiple CeAD. Interestingly, imaging evidence of cervical fibromuscular dysplasia (FMD) and presence of pseudoaneurysms were more common in patients with multiple CeAD. We do not have details on treatment, but 3-month modified Rankin score was similar between the two groups, and there were no deaths. Rate of CeAD recurrence was low in both groups. 

Although these results are unlikely to change management, I think it provides useful information. The finding of multiple CeAD being associated with an underlying vasculopathy should prompt us to search carefully for systemic vasculopathies such as FMD. There is little we can do about environmental triggers, but perhaps it sheds light on the pathophysiology. A previous paper from the CADISP group reported that hypertension could be a risk factor for CeAD.  Hypertension was more common in patients with multi-vessel CeAD.  Could this be contributing to the mechanism? Fortunately, the outcomes in multi-artery CeAD also appear favorable although severe cases of stroke or death may have been missed.