Abstract DP059: Incidence and Clinical Characteristics of Cervical Artery Dissection Following Chiropractic Cervical Manipulation: A Sub-Analysis of the STOP-CAD Study

Background: Cervical artery dissection (CeAD) is an important cause of stroke in young adults. Some studies reported that nearly 100 million cervical chiropractic manipulations occur in the US annually. The relationship between chiropractic cervical manipulation and CeAD remains a matter of debate, with few large-scale studies examining incidence and clinical characteristics. Methods: We analyzed patients in the multi-center STOP-CAD registry (n=4,023) to identify CeAD cases diagnosed after chiropractic cervical manipulation. Demographics and clinical features were compared between CeAD with vs. without antecedent chiropractic manipulation using chi-square tests and t-tests. We built a multivariable binary logistic regression model that included factors associated with preceding chiropractic manipulation in univariate analyses i.e. those with p<0.05. Results: Of 4,023 CeAD cases, 228 (5.7%) were diagnosed with dissection after chiropractic cervical manipulation which is estimated to be a rare occurrence after all cervical chiropractic manipulations. In multivariable binary logistic regression, factors associated with prior cervical manipulation were younger age (OR per year 0.98 95% CI 0.97-0.99, p = 0.014), female sex (OR 1.64, 95% CI 1.21–2.23), absence of diabetes (OR 0.24, 95% CI 0.08–0.78), presence of neck pain (OR 2.80, 95% CI 2.08–3.77), and isolated vertebral dissection (OR 2.15, 95% CI 1.57–2.94). Recurrent ischemic stroke rates did not differ between the two groups. Conclusions: Nearly 1 in 20 cases of dissection reported antecedent cervical manipulation. Given the high frequency of cervical chiropractic manipulations and very low rates of dissections diagnosed after chiropractic manipulations, the likely risk of dissection associated with chiropractic manipulations is very low. Dissections diagnosed after cervical manipulation have a distinct profile and were more likely in younger women presenting with neck pain and isolated vertebral artery involvement. Whether the occurrence dissection preceded the cervical manipulation or not remains unclear.

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Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.dp059
Primary Topic
Intracranial Aneurysms: Treatment and Complications
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article

Abstract DP059: Incidence and Clinical Characteristics of Cervical Artery Dissection Following Chiropractic Cervical Manipulation: A Sub-Analysis of the STOP-CAD Study

Jamil Said, Thaís Secchi, Vishnu Dantu, Setareh Salehi Omran et al.
Stroke
Intracranial Aneurysms: Treatment and Complications
article

Abstract DP059: Incidence and Clinical Characteristics of Cervical Artery Dissection Following Chiropractic Cervical Manipulation: A Sub-Analysis of the STOP-CAD Study

Jamil Said, Thaís Secchi, Vishnu Dantu, Setareh Salehi Omran, Adeel Zubair, Marwa Elnazeir, Mary Penckofer, Zedde Marialuisa, Varsha Muddasani, Rozaleen Aleyadeh, Faddi Saleh Velez, Anvesh Balabhadra, Xiaofan Guo, Richa Sharma, Fransisca Indraswari, D Liebeskind, Daniel M Mandel, Malik Ghannam, Cheran Elangovan, Mohammad AlMajali, Lily W. Zhou, Regina von Rennenberg, Ekaterina Bakradze, Joao Pedro Marto, Sheila Martins, Giovanna De Marco, Christopher Leon Guerrero, Reza Bavarsad Shahripour, Christopher Chang, Ana Fonseca, Victor Carrasco Wall, Ronen Leker, Jorge Ortiz Garcia, Nils Henninger, Alexandre Poppe, Shadi Yaghi, Piers Klein, Christoph Stretz, Abid Qureshi
article en

Abstract

Background: Cervical artery dissection (CeAD) is an important cause of stroke in young adults. Some studies reported that nearly 100 million cervical chiropractic manipulations occur in the US annually. The relationship between chiropractic cervical manipulation and CeAD remains a matter of debate, with few large-scale studies examining incidence and clinical characteristics. Methods: We analyzed patients in the multi-center STOP-CAD registry (n=4,023) to identify CeAD cases diagnosed after chiropractic cervical manipulation. Demographics and clinical features were compared between CeAD with vs. without antecedent chiropractic manipulation using chi-square tests and t-tests. We built a multivariable binary logistic regression model that included factors associated with preceding chiropractic manipulation in univariate analyses i.e. those with p<0.05. Results: Of 4,023 CeAD cases, 228 (5.7%) were diagnosed with dissection after chiropractic cervical manipulation which is estimated to be a rare occurrence after all cervical chiropractic manipulations. In multivariable binary logistic regression, factors associated with prior cervical manipulation were younger age (OR per year 0.98 95% CI 0.97-0.99, p = 0.014), female sex (OR 1.64, 95% CI 1.21–2.23), absence of diabetes (OR 0.24, 95% CI 0.08–0.78), presence of neck pain (OR 2.80, 95% CI 2.08–3.77), and isolated vertebral dissection (OR 2.15, 95% CI 1.57–2.94). Recurrent ischemic stroke rates did not differ between the two groups. Conclusions: Nearly 1 in 20 cases of dissection reported antecedent cervical manipulation. Given the high frequency of cervical chiropractic manipulations and very low rates of dissections diagnosed after chiropractic manipulations, the likely risk of dissection associated with chiropractic manipulations is very low. Dissections diagnosed after cervical manipulation have a distinct profile and were more likely in younger women presenting with neck pain and isolated vertebral artery involvement. Whether the occurrence dissection preceded the cervical manipulation or not remains unclear.

StrokeVol. 57(Suppl_1)
Boston University (US), University of Iowa (US), Barrow Neurological Institute (US), Universitat Oberta de Catalunya (ES), University of British Columbia (CA), University of Louisville (US), University of Bridgeport (US), University of Alberta (CA), University of Tennessee Health Science Center (US), Oklahoma City University (US), Brown University (US), UCLA Health (US), Hadassah Medical Center (IL), University of Alabama at Birmingham (US), Yale University (US), University of California San Diego (US), Hospital Moinhos de Vento (BR), NYU Langone Health (US), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), United Hospital Center (US), Hospital de Clínicas de Porto Alegre (BR), Hospital de Egas Moniz (PT), Aga Khan University Nairobi (KE), University of Kansas Medical Center (US), Centre Hospitalier de l’Université de Montréal (CA), Hackensack Meridian Health (US), Hospital de Santa Maria (PT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), UMass Memorial Medical Center (US), Wake Forest University (US), Mass General Brigham (US), University of Algarve (PT), Charité - Universitätsmedizin Berlin (DE), University of Oklahoma (US), The University of Texas Health Science Center at Houston (US), University of Colorado Denver (US)
Openalex Percentile: Top 76%
Intracranial Aneurysms: Treatment and Complications
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