Abstract WP127: Sex-Specific Differences in Presentation and Outcomes after Cervical Artery Dissection

Background and Objectives: Cervical artery dissection (CeAD) is a leading cause of ischemic stroke in younger adults, yet sex-specific variations in its clinical presentation, imaging characteristics, and outcomes remain underexplored. We aimed to evaluate these differences using data from a large, multicenter registry. Methods: We analyzed data from the STOP-CAD registry, which includes patients with radiologically confirmed non-traumatic CeAD enrolled between 2015 and 2021 across multiple centers. Clinical and imaging characteristics were compared between men and women using multivariable logistic regression. Outcomes assessed included ischemic stroke recurrence at 180 days, excellent functional outcome (modified Rankin Scale [mRS] 0–1) at 90 days, symptomatic intracerebral hemorrhage (sICH), and mortality. Results: Among 4,023 patients with CeAD, 1,783 (44.6%) were women. Compared to men, women were younger (median age: 42 vs 50 years), more likely to have a history of migraine (26.9% vs 8.3%) and connective tissue disorders (14.3% vs 5.8%), and presented more frequently with non-ischemic symptoms such as headache, neck pain, or tinnitus (adjusted OR [aOR] 2.0; 95% CI, 1.8–2.3; p<0.001). Women had significantly higher odds of vertebral artery dissection (OR, 1.3; 95% CI, 1.2-1.5; p<0.001), multivessel involvement (OR, 2.1; 95% CI, 1.7-2.5; p<0.001), and pseudoaneurysm formation (OR, 1.3; 95% CI, 1.1-1.6; p=0.003). Despite these differences, there was no significant sex-based difference in key clinical outcomes: excellent functional recovery at 90 days (OR 0.94; 95% CI 0.76-1.15 p=0.542), ischemic stroke recurrence at 180 days (OR 0.56 CI 0.23-1.3 p=0.213), or mortality (OR 0.83; 95% CI 0.47-1.48, p=0.529). Conclusion: In this large international cohort, we observed women with CeAD were younger, more likely to present with non-ischemic symptoms with distinct imaging features. These underscore the need for heightened clinical suspicion of CeAD in women presenting with atypical symptoms, even in the absence of ischemic deficits or conventional vascular risk factors, and suggest that sex-specific phenotyping may enhance diagnostic accuracy and early management.

Authors

Institutions

Publication Details

Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.wp127
Primary Topic
Intracranial Aneurysms: Treatment and Complications
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Abstract WP127: Sex-Specific Differences in Presentation and Outcomes after Cervical Artery Dissection

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

Abstract WP127: Sex-Specific Differences in Presentation and Outcomes after Cervical Artery Dissection

Ossama Khazaal, Dania Mallick, Setareh Salehi Omran, Adeel Zubair, Marwa Elnazeir, Zedde Marialuisa, 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, Michele Romoli, Ahmad Nehme, 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, Ligi Shu, Ross Crandell, Zafer Keser, Shadi Yaghi, Mary Penckofer, Edgar A. Samaniego, Piers Klein, Thanh N. Nguyen
article en

Abstract

Background and Objectives: Cervical artery dissection (CeAD) is a leading cause of ischemic stroke in younger adults, yet sex-specific variations in its clinical presentation, imaging characteristics, and outcomes remain underexplored. We aimed to evaluate these differences using data from a large, multicenter registry. Methods: We analyzed data from the STOP-CAD registry, which includes patients with radiologically confirmed non-traumatic CeAD enrolled between 2015 and 2021 across multiple centers. Clinical and imaging characteristics were compared between men and women using multivariable logistic regression. Outcomes assessed included ischemic stroke recurrence at 180 days, excellent functional outcome (modified Rankin Scale [mRS] 0–1) at 90 days, symptomatic intracerebral hemorrhage (sICH), and mortality. Results: Among 4,023 patients with CeAD, 1,783 (44.6%) were women. Compared to men, women were younger (median age: 42 vs 50 years), more likely to have a history of migraine (26.9% vs 8.3%) and connective tissue disorders (14.3% vs 5.8%), and presented more frequently with non-ischemic symptoms such as headache, neck pain, or tinnitus (adjusted OR [aOR] 2.0; 95% CI, 1.8–2.3; p<0.001). Women had significantly higher odds of vertebral artery dissection (OR, 1.3; 95% CI, 1.2-1.5; p<0.001), multivessel involvement (OR, 2.1; 95% CI, 1.7-2.5; p<0.001), and pseudoaneurysm formation (OR, 1.3; 95% CI, 1.1-1.6; p=0.003). Despite these differences, there was no significant sex-based difference in key clinical outcomes: excellent functional recovery at 90 days (OR 0.94; 95% CI 0.76-1.15 p=0.542), ischemic stroke recurrence at 180 days (OR 0.56 CI 0.23-1.3 p=0.213), or mortality (OR 0.83; 95% CI 0.47-1.48, p=0.529). Conclusion: In this large international cohort, we observed women with CeAD were younger, more likely to present with non-ischemic symptoms with distinct imaging features. These underscore the need for heightened clinical suspicion of CeAD in women presenting with atypical symptoms, even in the absence of ischemic deficits or conventional vascular risk factors, and suggest that sex-specific phenotyping may enhance diagnostic accuracy and early management.

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 74%
Intracranial Aneurysms: Treatment and Complications
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.