UNDERLYING ARTERIOPATHY IN PATIENTS WITH SPONTANEOUS CERVICAL ARTERY DISSECTION: FIBROMUSCULAR DYSPLASIA AND BEYOND

Objective: Spontaneous cervical artery dissection (sCeAD) accounts for up to 25% of stroke in young and middle-aged adults. Although growing evidence showed a potential link between fibromuscular dysplasia (FMD) and sCeAD, the magnitude of this association remains uncertain, since data available derive from uncompleted vascular screening. This study aims to assess the frequency and types of cervical and extra-cervical arterial lesions, particularly of the FMD type, in a cohort of patients with a primary diagnosis of sCeAD. Design and method: We recruited all patients admitted with a diagnosis of sCeAD from January 2016 to December 2023. All patients underwent full-body vascular imaging screening to assess the presence of cervical and extra-cervical vascular abnormalities (multifocal and focal stenosis, aneurysms, dissections, tortuosity, ectasia/dilatation or parietal irregularities). Results: Of the 94 patients included (65.7% male; 48.8±8.7 y.o.), carotid artery dissection was observed in 90.4% of patients while vertebral artery dissection in 14.9%, with 9.6% of patients experiencing recurrent sCeAD. Thirty patients (31.9%) had imaging evidence of cerebrovascular FMD, with main involvement of the internal carotid artery (89.7%). In the 61 patients with a whole-body vascular screening, all-type of extra-cervical vascular abnormalities were identified in 47.5% of patients. Twenty-one% of patients (21.3%) had evidence of extra-cervical FMD, affecting renal (11.5%), visceral (13.1%) and limb (6.7%) arteries. Prevalence of extra-cervical dissections and aneurysms was 14.8% and 9.8%, respectively. After a whole-body screening, overall prevalence of FMD raised from 32.8% to 39.3%. Patients with FMD were mainly female (p<0.0001), had a history of migraine (p=0.023) and recurrent sCeADs (p=0.025). After a multivariate analysis, female sex (P<0.0001) and, almost, a positive history of recurrent sCeADs (P=0.053) were identified as significant predictors of FMD presence in patients with sCeADs. Conclusions: The study reveals a high prevalence of FMD and other vascular abnormalities in patients with sCeAD, highlighting the importance of a comprehensive vascular screening, especially in women and in patients with a positive history of recurrent sCeAD.