Objective Cervical artery dissection (CAD) accounts for 10–20% of all strokes in young adults, but no randomised controlled trial has investigated the best secondary prevention after ischaemic stroke or transient ischaemic attack (TIA). Because only small numbers of patient with CAD have been prospectively documented and followed up, the authors aimed to investigate the prognosis under various prevention regimens.
Methods 30 German departments of neurology with acute stroke units prospectively documented 250 patients with acute ischaemic stroke or TIA due to CAD. A central follow-up (median 31 months) assessed recurrent stroke, recurrent CAD and death in 198 patients.
Results CAD was found more often in the carotid arteries (52.0%) than in the vertebral arteries (46.8%). Thirteen patients (5.2%, CI 3.1% to 8.6%) suffered a recurrent stroke during the acute hospital stay. The rate of recurrent CAD during the first year was 1.7% (95% CI 0.3% to 3.6%). The cumulative recurrent stroke rate during the first year was 10.7% (95% CI 6.5% to 14.9%) and 14.0% (95% CI 8.9% to 19.1%) over 3 years. After discharge, the rate of recurrent stroke up to 6 months in patients treated with anticoagulants was 2.0% (95% CI 0.6% to 7.1%) and in those treated with antiplatelets 16.7% (95% CI 5.8% to 39.2%), which was statistically significant (HR 0.11; CI 0.02 to 0.69, p=0.02).
Conclusions This observational study confirms a high risk of early recurrent stroke following acute IS or TIA due to CAD. Whether anticoagulation provides any benefit over antiplatelets needs to be investigated in a randomised controlled trial.
- arterial dissection
- long-term prognosis
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↵* Participating departments of Neurology (investigator): Ostalbklinikum Aalen (M Heyden), Krankenanstalten Gilead Bielefeld (C Hagemeister), Knappschaftskrankenhaus Bochum (S Skodda), Rheinische Landesklinik Bonn (R Biniek), Städtisches Klinikum Braunschweig (S Hengst), Klinikum Bremen-Mitte (F Brunner), Krankenhaus Buchholz (K Luckner), Klinikum Duisburg (K Ulrich), Universitätsklinikum of Essen (C Weimar), Universitätsklinikum Freiburg (C Haverkamp), Universitätsklinikum Greifswald (A Khaw), Allgemeines Krankenhaus Hamburg-Altona (P Michels), Universitätsklinikum Hannover (K Weissenborn), Kreiskrankenhaus Heidenheim (S Kaendler), Universitätsklinikum Homburg (P Kostopoulos), Klinikum Itzehoe (S Jachmann), Universitätsklinikum Jena (C Terborg), Universitätsklinikum Kiel (C Eschenfelder), Universitätsklinikum Köln (J Sobesky), Krankenhaus Köln-Mehrheim (U Frost), Universitätsklinikum Leipzig (D Michalski), Universitätsklinikum Magdeburg (M Goertler), Krankenhaus München-Harlaching (H Audebert), Universitätsklinikum München-Großhadern (M Dichgans), Kliniken Neuruppin (G Zindler), Universitätsklinikum Rostock (A Kloth), Bürgerhospital Stuttgart (T Mieck), Universitätsklinikum Ulm (R Huber), Sophien- und Hufeland Klinikum Weimar (P Möller), Heinrich-Braun-Krankenhaus Zwickau (S Grieshammer).
Funding This study was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DI 327/8-1, DI 327/9-1).
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was provided by the Medical faculty, University of Duisburg-Essen.
Provenance and peer review Not commissioned; externally peer reviewed.