Abstract A048: De Novo Pseudoaneurysm Formation After Cervical Artery Dissection: Incidence, Risk Factors, and Outcomes

Background: The clinical characteristics and complications associated with de novo pseudoaneurysm formation beyond the acute phase of cervical artery dissection remain poorly defined. In this study, we examined the incidence, risk factors, and related ischemic and hemorrhagic events of post-acute de novo pseudoaneurysm formation. Methods: We analyzed data from the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection). A de novo pseudoaneurysm was defined as a new (not present on initial imaging) focal enlargement in the diameter of the artery, greater than the native lumen. The incidence of de novo pseudoaneurysm was assessed at 90 days, 180 days, and beyond 180 days of follow-up. Univariate and multivariate regression analyses were conducted to identify risk factors for post-acute de novo pseudoaneurysm formation. Kaplan-Meier survival estimates were used to compare ischemic and hemorrhagic events between patients with and without de novo pseudoaneurysms. Results: Among 4008 patients, 546 were excluded as they had dissecting pseudoaneursyms on initial presentation. Therefore, 3,462 patients were included in this analysis of whom 220 patients (6.35%) developed a de novo pseudoaneurysm over a maximum follow-up of 4.4 years. Of these, 127 (57.72%) were detected within the first 90 days, and 172 (78.18%) within the first 180 days. In multivariate regression analyses, in addition to hypertension, active smoking and Hispanic ethnicity, fibromuscular dysplasia (FMD) was an independent risk factor for post-acute de novo pseudoaneurysm formation (adjusted OR: 2.160; 95% CI: 1.408–3.315; p < 0.001). Notably, the presence of a de novo pseudoaneurysm was not associated with a significant increase in ischemic (hazard ratio [HR] 1.43 [95% CI, 0.89–2.30]; P=0.14) or hemorrhagic events (hazard ratio [HR] 1.42 [95% CI, 0.43–4.69]; P=0.57). Conclusion: De novo pseudoaneurysm formation following a diagnosis of a cervical artery dissection is not uncommon and most frequently occurs within the first 180 days. FMD was independently associated with this complication. The development of a de novo pseudoaneurysm did not significantly increase the risk of subsequent ischemic or hemorrhagic events.

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Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.a048
Primary Topic
Intracranial Aneurysms: Treatment and Complications
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article
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article

Abstract A048: De Novo Pseudoaneurysm Formation After Cervical Artery Dissection: Incidence, Risk Factors, and Outcomes

Wayneho Kam, Ossama Khazaal, Dania Mallick, Setareh Salehi Omran et al.
Stroke
Intracranial Aneurysms: Treatment and Complications
article

Abstract A048: De Novo Pseudoaneurysm Formation After Cervical Artery Dissection: Incidence, Risk Factors, and Outcomes

Wayneho Kam, Ossama Khazaal, Dania Mallick, Setareh Salehi Omran, Ross Crandall, Adeel Zubair, Marwa Elnazeir, Zedde Marialuisa, Liqi Shu, Kim Griffin, Brian Mac Grory, James Ernest Siegler, Faddi Saleh Velez, Ana Catarina Fonseca, Anvesh Balabhadra, Alexis N. Simpkins, Mirjam R. Heldner, Muhib Khan, Evan Lester, Michele Romoli, Ahmad Nehme, Daniel M Mandel, Stefan T Engelter, Issa Metanis, Malik Ghannam, Mohammad AlMajali, Ekaterina Bakradze, Joao Pedro Marto, Diana Cruz, Reza Bavarsad Shahripour, Shadi Yaghi, Syed Daniyal Asad, Aaron Rothstein, Ronen Leker, Sami Al Kasab, Mohamad AbdalKader, Thanh N. Nguyen, Elizabeth M. Lee, Melanie Ho, Christian H. Nolte, Nils Henninger, Zafer Keser, Piers Klein, Edgar A. Samaniego, Christoph Stretz, Shayak Sen
article en

Abstract

Background: The clinical characteristics and complications associated with de novo pseudoaneurysm formation beyond the acute phase of cervical artery dissection remain poorly defined. In this study, we examined the incidence, risk factors, and related ischemic and hemorrhagic events of post-acute de novo pseudoaneurysm formation. Methods: We analyzed data from the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection). A de novo pseudoaneurysm was defined as a new (not present on initial imaging) focal enlargement in the diameter of the artery, greater than the native lumen. The incidence of de novo pseudoaneurysm was assessed at 90 days, 180 days, and beyond 180 days of follow-up. Univariate and multivariate regression analyses were conducted to identify risk factors for post-acute de novo pseudoaneurysm formation. Kaplan-Meier survival estimates were used to compare ischemic and hemorrhagic events between patients with and without de novo pseudoaneurysms. Results: Among 4008 patients, 546 were excluded as they had dissecting pseudoaneursyms on initial presentation. Therefore, 3,462 patients were included in this analysis of whom 220 patients (6.35%) developed a de novo pseudoaneurysm over a maximum follow-up of 4.4 years. Of these, 127 (57.72%) were detected within the first 90 days, and 172 (78.18%) within the first 180 days. In multivariate regression analyses, in addition to hypertension, active smoking and Hispanic ethnicity, fibromuscular dysplasia (FMD) was an independent risk factor for post-acute de novo pseudoaneurysm formation (adjusted OR: 2.160; 95% CI: 1.408–3.315; p < 0.001). Notably, the presence of a de novo pseudoaneurysm was not associated with a significant increase in ischemic (hazard ratio [HR] 1.43 [95% CI, 0.89–2.30]; P=0.14) or hemorrhagic events (hazard ratio [HR] 1.42 [95% CI, 0.43–4.69]; P=0.57). Conclusion: De novo pseudoaneurysm formation following a diagnosis of a cervical artery dissection is not uncommon and most frequently occurs within the first 180 days. FMD was independently associated with this complication. The development of a de novo pseudoaneurysm did not significantly increase the risk of subsequent ischemic or hemorrhagic events.

StrokeVol. 57(Suppl_1)
Boston University (US), University of Bern (CH), University of Iowa (US), Cedars-Sinai Medical Center (US), Hartford Hospital (US), University of Minnesota (US), Mayo Clinic (US), University of Wisconsin–Madison (US), University of Louisville (US), Medical University of South Carolina (US), University of Tennessee Health Science Center (US), Duke University (US), University of Basel (CH), Providence College (US), Cornell University (US), Brown University (US), Hadassah Medical Center (IL), University of Minnesota System (US), Rhode Island Hospital (US), University Hospital of Bern (CH), University of Alabama at Birmingham (US), Yale University (US), University of California San Diego (US), University of Chicago (US), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), United Hospital Center (US), Normandie Université (FR), Hospital de Egas Moniz (PT), Ospedale “M. Bufalini” di Cesena (IT), Temple University Hospital (US), Hospital de Santa Maria (PT), UMass Memorial Medical Center (US), Charité - Universitätsmedizin Berlin (DE), University of Pennsylvania (US), University of Oklahoma (US), The University of Texas Health Science Center at Houston (US), University of Colorado Denver (US)
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Intracranial Aneurysms: Treatment and Complications
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