Abstract
Long-term consequences of cervical artery dissection (CeAD), a major cause of ischemic stroke in young people, have been poorly investigated. The Italian Project on Stroke at Young Age – Cervical Artery Dissection (IPSYS CeAD) project is a multicenter, hospital-based, consecutively recruiting, observational, cohort study aimed to address clinically important questions about long-term outcome of CeAD patients, which are not covered by other large-scale registries. Patients with radiologically diagnosed CeAD were consecutively included in the registry. Baseline demographic and clinical variables, as well as information on risk factors, were systematically collected for each eligible patient. Follow-up evaluations were conducted between 3 and 6 months after the initial event (t1) and then annually (t2 at 1 year, t3 at 2 years , and so on), in order to assess outcome events (long-term recurrent CeAD, any fatal/nonfatal ischemic stroke, transient ischemic attack (TIA), or other arterial thrombotic event, and death from any cause). Between 2000 and 2019, data from 1530 patients (age at diagnosis, 47.2 ± 11.5 years; women, 660 [43.1%]) have been collected at 39 Italian neurological centers. Dissection involved a single vessel in 1308 (85.5%) cases and caused brain ischemia in 1303 (85.1%) (190 TIA/1113 ischemic stroke). Longitudinal data are available for 1414 (92.4%) patients (median follow-up time in patients who did not experience recurrent events, 36.0 months [25th to 75th percentile, 63.0]). The collaborative IPSYS CeAD effort will provide novel information on the long-term outcome of CeAD patients. This could allow for tailored treatment approaches based on patients’ individual characteristics.
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References
Debette S, Leys D (2009) Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 8:668–678
Dittrich R, Nassenstein I, Bachmann R, Maintz D, Nabavi DG, Heindel W, Kuhlenbäumer G, Ringelstein EB (2007) Polyarterial clustered recurrence of cervical artery dissection seems to be the rule. Neurology 69:180–186
Compter A, Schilling S, Vaineau CJ, Goeggel-Simonetti B, Metso TM, Southerland A, Pezzini A, Kloss M, Touzé E, Worrall BB, Thijs V, Bejot Y, Reiner P, Grond-Ginsbach C, Bersano A, Brandt T, Caso V, Lyrer PA, Traenka C, Lichy C, Martin JJ, Leys D, Sarikaya H, Baumgartner RW, Jung S, Fischer U, Engelter ST, Dallongeville J, Chabriat H, Tatlisumak T, Bousser MG, Arnold M, Debette S, CADISP-plus Consortium (2018) Determinants and outcome of multiple and early recurrent cervical artery dissections. Neurology 91:e769–e780
Schievink WI, Mokri B, O’Fallon WM (1994) Recurrent spontaneous cervical-artery dissection. N Engl J Med 330:393–397
Kloss M, Grond-Ginsbach C, Ringleb P, Hausser I, Hacke W, Brandt T (2018) Recurrence of cervical artery dissection: an underestimated risk. Neurology 90:e1372–e1378
Pezzini A, Grassi M, Lodigiani C, Patella R, Gandolfo C, Casoni F, Musolino R, Calabrò RS, Bovi P, Adami A, Delodovici ML, Del Zotto E, Rota LL, Rasura M, Del Sette M, Giossi A, Volonghi I, Zini A, Cerrato P, Costa P, Magoni M, Iacoviello L, Padovani A, Italian Project on Stroke in Young Adults Investigators (2011) Predictors of migraine subtypes in young adults with ischemic stroke: the Italian Project on Stroke in Young Adults. Stroke 42:17–21
De Giuli V, Grassi M, Lodigiani C, Patella R, Zedde M, Gandolfo C, Zini A, DeLodovici ML, Paciaroni M, Del Sette M, Azzini C, Toriello A, Musolino R, Calabrò RS, Bovi P, Sessa M, Adami A, Silvestrelli G, Cavallini A, Marcheselli S, Bonifati DM, Checcarelli N, Tancredi L, Chiti A, Lotti EM, Del Zotto E, Tomelleri G, Spalloni A, Giorli E, Costa P, Poli L, Morotti A, Caria F, Lanari A, Giacalone G, Ferrazzi P, Giossi A, Piras V, Massucco D, D'Amore C, Di Lisi F, Casetta I, Cucurachi L, Cotroneo M, De Vito A, Coloberti E, Rasura M, Simone AM, Gamba M, Cerrato P, Micieli G, Malferrari G, Melis M, Iacoviello L, Padovani A, Pezzini A, Italian Project on Stroke in Young Adults Investigators (2017) Association between migraine and cervical artery dissection: the Italian Project on Stroke in Young Adults. JAMA Neurol 74:512–518
Headache Classification Committee of the International Headache Society (1988) Classification and diagnostic criteria for headache disorders cranial neuralgias and facial pain. Cephalalgia 8(Suppl 7):1–96
Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders. Cephalalgia 24(Suppl 1):24–36
Headache Classification Committee of the International Headache Society (IHS) (2013) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 33:629–808
De Giuli V, Graziano F, Zini A, Zedde M, Patella R, Lodigiani C, Marcheselli S, DeLodovici ML, Paciaroni M, Casetta I, Giorli E, Adami A, Braga M, Casella C, Giossi A, Silvestrelli G, Tancredi L, Lotti EM, Poli L, Caria F, Piras V, Cucurachi L, Gamba M, Grassi M, Padovani A, Pezzini A, Italian Project on Stroke in Young Adults (IPSYS) Investigators (2019) Migraine improvement after spontaneous cervical artery dissection. The Italian Project on Stroke in Young Adults (IPSYS). Neurol Sci 40(1):59–66
Walton KA, Buono LM (2003) Horner syndrome. Curr Opin Ophthalmol 14:357–363
Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870
Debette S, Metso T, Pezzini A, Abboud S, Metso A, Leys D, Bersano A, Louillet F, Caso V, Lamy C, Medeiros E, Samson Y, Grond-Ginsbach C, Engelter ST, Thijs V, Beretta S, Béjot Y, Sessa M, Lorenza Muiesan M, Amouyel P, Castellano M, Arveiler D, Tatlisumak T, Dallongeville J, Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) Group (2011) Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation 123(14):1537–1544
Arnold M, Kappeler L, Georgiadis D, Berthet K, Keserue B, Bousser MG, Baumgartner RW (2006) Gender differences in spontaneous cervical artery dissection. Neurology 67:1050–1052
Funding
The Italian Project on Stroke in Young Adults (IPSYS) is supported by a grant from the Associazione per la Lotta alla Trombosi e alle Malattie Cardiovascolari (ALT).
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The study design was approved by the Ethical Committee of the Spedali Civili di Brescia, Italy (NP 74, 04/05/2010). Written, signed consent will be obtained from all participants or their legal representatives. Participants have the right to withdraw from the research process at any time throughout the study. All data are kept strictly confidential and patients are given a study ID number to maintain this confidentiality. Participation in this study does not interfere with usual patient care.
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Bonacina, S., Grassi, M., Zedde, M. et al. Long-term outcome of cervical artery dissection. Neurol Sci 41, 3265–3272 (2020). https://doi.org/10.1007/s10072-020-04464-9
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DOI: https://doi.org/10.1007/s10072-020-04464-9