Abstract WP121: Pregnancy-Associated Cervical Artery Dissection: STOP-CAD Analysis

Background and Objectives: Pregnancy and the postpartum period increase the risk of cervical artery dissection (CEAD), a notable cause of stroke in young women. We aimed to describe the clinical presentation, imaging findings, and outcomes of CEAD occurring during pregnancy or shortly after delivery. Methods: We analyzed data from the STOP-CAD registry, a large international multicenter study of patients treated with antithrombotic therapy for non-traumatic CEAD between 2015 and 2021. This sub-study focused on women who were pregnant or within 12 weeks postpartum at the time of symptom onset. We assessed baseline clinical features, imaging results, acute stroke treatments, and functional outcomes. Results: Among 1,783 women in the registry, 62 (3.5%) had pregnancy-associated CEAD, with a median age of 34 years (IQR, 30-38). One-third had a history of migraine (33.9%), one-fifth had hypertension (21.0%), while other vascular risk factors were rare. Recent minor neck trauma was reported in 17.7%. Ischemic stroke symptoms occurred in 25 (40.3%) patients, and 23 (37.1%) had acute infarcts on imaging. However, most (59.7%) presented with non-ischemic symptoms. Vertebral artery dissections were more common than carotid dissections (62.9% vs. 48.4%), and 33.9% had multivessel involvement. Among patients presenting with ischemic stroke symptoms, 4 received thrombolysis and 7 underwent thrombectomy. Remarkably, 92% had excellent functional recovery (modified Rankin Score 0–1) at 90 days, and there were no stroke recurrences at 180 days. Conclusion: Pregnancy- and postpartum-associated CEAD is uncommon and associated with ischemic stroke in nearly half of patients. A history of migraine and hypertension may be potential risk factors. Despite the severity of presentation, most patients had favorable outcomes with timely treatment.

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Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.wp121
Primary Topic
Intracranial Aneurysms: Treatment and Complications
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article

Abstract WP121: Pregnancy-Associated Cervical Artery Dissection: STOP-CAD Analysis

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

Abstract WP121: Pregnancy-Associated Cervical Artery Dissection: STOP-CAD Analysis

Ossama Khazaal, Dania Mallick, Setareh Salehi Omran, Adeel Zubair, Marwa Elnazeir, Mary Penckofer, Zedde Marialuisa, Liqi Shu, Brian Mac Grory, Preet Gandhi, Faddi Saleh Velez, Muhammed Enes Gunduz, Josefin E. Kaufmann, Xiaofan Guo, Joshua Z. Willey, Jayachandra Muppa, Alexis N. Simpkins, J Siegler, Mirjam R. Heldner, Antonenko Katheryna, Diana Cruz, Christian Sidebottom, Muhib Khan, Evan Lester, Piers Klein, Michele Romoli, Stefan T Engelter, Issa Metanis, Malik Ghannam, Cheran Elangovan, Mohammad AlMajali, Farid Khasiyev, Ekaterina Bakradze, Joao Pedro Marto, Conner Lee, Ana Fonseca, Reza Bavarsad Shahripour, Regina Von Renneberg, Aaron Rothstein, Ronen Leker, Nils Henninger, Ross Crandell, Zafer Keser, Shadi Yaghi, Edgar A. Samaniego, Nehme Ahmad, Thanh N. Nguyen
article en

Abstract

Background and Objectives: Pregnancy and the postpartum period increase the risk of cervical artery dissection (CEAD), a notable cause of stroke in young women. We aimed to describe the clinical presentation, imaging findings, and outcomes of CEAD occurring during pregnancy or shortly after delivery. Methods: We analyzed data from the STOP-CAD registry, a large international multicenter study of patients treated with antithrombotic therapy for non-traumatic CEAD between 2015 and 2021. This sub-study focused on women who were pregnant or within 12 weeks postpartum at the time of symptom onset. We assessed baseline clinical features, imaging results, acute stroke treatments, and functional outcomes. Results: Among 1,783 women in the registry, 62 (3.5%) had pregnancy-associated CEAD, with a median age of 34 years (IQR, 30-38). One-third had a history of migraine (33.9%), one-fifth had hypertension (21.0%), while other vascular risk factors were rare. Recent minor neck trauma was reported in 17.7%. Ischemic stroke symptoms occurred in 25 (40.3%) patients, and 23 (37.1%) had acute infarcts on imaging. However, most (59.7%) presented with non-ischemic symptoms. Vertebral artery dissections were more common than carotid dissections (62.9% vs. 48.4%), and 33.9% had multivessel involvement. Among patients presenting with ischemic stroke symptoms, 4 received thrombolysis and 7 underwent thrombectomy. Remarkably, 92% had excellent functional recovery (modified Rankin Score 0–1) at 90 days, and there were no stroke recurrences at 180 days. Conclusion: Pregnancy- and postpartum-associated CEAD is uncommon and associated with ischemic stroke in nearly half of patients. A history of migraine and hypertension may be potential risk factors. Despite the severity of presentation, most patients had favorable outcomes with timely treatment.

StrokeVol. 57(Suppl_1)
University of Iowa (US), Cedars-Sinai Medical Center (US), Boston Medical Center (US), Mayo Clinic (US), Bowdoin College (US), University of British Columbia (CA), Saint Leo University (US), University of Louisville (US), University of Tennessee Health Science Center (US), University of Massachusetts Chan Medical School (US), Duke University (US), University of Basel (CH), Cornell University (US), Brown University (US), Hadassah Medical Center (IL), Rhode Island Hospital (US), Cooper University Hospital (US), University Hospital of Bern (CH), University Hospital of Basel (CH), University of Alabama at Birmingham (US), Yale University (US), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Normandie Université (FR), Hospital de Egas Moniz (PT), Administração Regional de Saúde de Lisboa e Vale do Tejo (PT), Ospedale “M. Bufalini” di Cesena (IT), Temple University Hospital (US), Hackensack Meridian Health (US), Hospital de Santa Maria (PT), UMass Memorial Medical Center (US), Columbia University (US), Charité - Universitätsmedizin Berlin (DE), University of Pennsylvania (US), University of Oklahoma (US), University of Colorado Denver (US)
Good health and well-being
Openalex Percentile: Top 76%
Intracranial Aneurysms: Treatment and Complications
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