Abstract A132: Young Adults with Cervical Artery Dissection have a Distinct Clinical Phenotype: A Post-Hoc Analysis of the STOP-CAD Study

Background and Objectives: Cervical artery dissection (CeAD) is a common cause of ischemic stroke in young adults. We aim to identify age-based differences in clinical presentation, imaging findings, and outcomes after CeAD. Methods: This was a sub-study using the STOP-CAD registry, a multicenter cross-sectional international retrospective study of patients diagnosed with CeAD and treated with an antithrombotic from January 1, 2015 to December 31, 2021. Baseline clinical and imaging characteristics were compared between younger and older adults with CeAD (≤45 versus >45 years of age) using multivariable logistic regression. We chose this age cut off due to its frequent usage in stroke in the young literature. Multiple logistic regression models were used to determine association between young age and outcomes after CeAD (ischemic stroke at 180 days, excellent functional outcome with modified Rankin Scale of 0-1 at 90 days, and mortality) after adjusting for sex, vascular risk factors, CeAD characteristics, and NIHSS on presentation. Results: Among 4023 CeAD patients included in the study, 1901 (47.3%) were ≤45 years of age. Patients were followed for a median of 307 days (IQR 102-831). Young adults with CeAD were more likely to be women (Odds Ratio [OR], 2.4; 95% CI, 2.1-2.9; p<0.001), of Hispanic ethnicity (OR, 1.8; 95% CI 1.3-2.5; p<0.001), have a history of migraines (OR, 1.6; 95% CI, 1.3-2.0; p<0.001) and recent neck trauma (OR, 1.6; 95% CI, 1.3-1.9; p<0.001) while having fewer traditional vascular risk factors. Young adults with CeAD had higher odds of a non-ischemic presentation (OR, 1.3; 95% CI, 1.1-1.5; p=0.013), vertebral artery dissection (OR 2.5; 95% CI, 2.2-3.0; p<0.001), and multivessel involvement (OR 1.5; 95% CI, 1.1-1.9; p=0.004). In adjusted analysis, younger age was not associated with an increased risk of recurrent ischemic stroke (adjusted Hazard Ratio [HR], 0.48; 95% CI 0.2-1.2; p=0.119). Younger age was associated with significantly greater odds of excellent functional outcome at 90 days (aOR, 1.48; 1.20-1.84, p<0.001) and lower risk of death at follow up (aHR, 0.37; 95% CI, 0.17-0.81; p=0.012) after CeAD. Conclusion: In a large international cohort, young adults with CeAD had a distinct clinical phenotype with higher odds of non-ischemic presentation, vertebral artery dissection, and multivessel involvement while having fewer traditional vascular risk factors. Young adults had a decreased odds of disability and mortality after CeAD.

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Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.a132
Primary Topic
Intracranial Aneurysms: Treatment and Complications
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article

Abstract A132: Young Adults with Cervical Artery Dissection have a Distinct Clinical Phenotype: A Post-Hoc Analysis of the STOP-CAD Study

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

Abstract A132: Young Adults with Cervical Artery Dissection have a Distinct Clinical Phenotype: A Post-Hoc Analysis of the STOP-CAD Study

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

Abstract

Background and Objectives: Cervical artery dissection (CeAD) is a common cause of ischemic stroke in young adults. We aim to identify age-based differences in clinical presentation, imaging findings, and outcomes after CeAD. Methods: This was a sub-study using the STOP-CAD registry, a multicenter cross-sectional international retrospective study of patients diagnosed with CeAD and treated with an antithrombotic from January 1, 2015 to December 31, 2021. Baseline clinical and imaging characteristics were compared between younger and older adults with CeAD (≤45 versus >45 years of age) using multivariable logistic regression. We chose this age cut off due to its frequent usage in stroke in the young literature. Multiple logistic regression models were used to determine association between young age and outcomes after CeAD (ischemic stroke at 180 days, excellent functional outcome with modified Rankin Scale of 0-1 at 90 days, and mortality) after adjusting for sex, vascular risk factors, CeAD characteristics, and NIHSS on presentation. Results: Among 4023 CeAD patients included in the study, 1901 (47.3%) were ≤45 years of age. Patients were followed for a median of 307 days (IQR 102-831). Young adults with CeAD were more likely to be women (Odds Ratio [OR], 2.4; 95% CI, 2.1-2.9; p<0.001), of Hispanic ethnicity (OR, 1.8; 95% CI 1.3-2.5; p<0.001), have a history of migraines (OR, 1.6; 95% CI, 1.3-2.0; p<0.001) and recent neck trauma (OR, 1.6; 95% CI, 1.3-1.9; p<0.001) while having fewer traditional vascular risk factors. Young adults with CeAD had higher odds of a non-ischemic presentation (OR, 1.3; 95% CI, 1.1-1.5; p=0.013), vertebral artery dissection (OR 2.5; 95% CI, 2.2-3.0; p<0.001), and multivessel involvement (OR 1.5; 95% CI, 1.1-1.9; p=0.004). In adjusted analysis, younger age was not associated with an increased risk of recurrent ischemic stroke (adjusted Hazard Ratio [HR], 0.48; 95% CI 0.2-1.2; p=0.119). Younger age was associated with significantly greater odds of excellent functional outcome at 90 days (aOR, 1.48; 1.20-1.84, p<0.001) and lower risk of death at follow up (aHR, 0.37; 95% CI, 0.17-0.81; p=0.012) after CeAD. Conclusion: In a large international cohort, young adults with CeAD had a distinct clinical phenotype with higher odds of non-ischemic presentation, vertebral artery dissection, and multivessel involvement while having fewer traditional vascular risk factors. Young adults had a decreased odds of disability and mortality after CeAD.

StrokeVol. 57(Suppl_1)
Cedars-Sinai Medical Center (US), Boston Medical Center (US), Mayo Clinic (US), Bowdoin College (US), University of British Columbia (CA), 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), Brown University (US), Columbia University Irving Medical Center (US), Ochsner Medical Center (US), Hadassah Medical Center (IL), Rhode Island Hospital (US), University Hospital of Bern (CH), University of Iowa Hospitals and Clinics (US), University Hospital of Basel (CH), University of Alabama at Birmingham (US), Yale University (US), Humboldt-Universität zu Berlin (DE), University of Chicago (US), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Normandie Université (FR), Hospital de Egas Moniz (PT), Ospedale “M. Bufalini” di Cesena (IT), Temple University Hospital (US), Hospital de Santa Maria (PT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Cooper University Health Care (US), Columbia University (US), University of Pennsylvania (US), University of Oklahoma (US), University of Colorado Denver (US)
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Openalex Percentile: Top 74%
Intracranial Aneurysms: Treatment and Complications
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