Abstract DP029: Incidence, risk factors, aneurysm growth, and outcomes of cervical artery dissection patients with dissecting aneurysm: STOP-CAD subanalysis

Background: Cervical artery dissection (CeAD) accounts for nearly 25% of all ischemic strokes in young adults. CeAD can lead to the development of dissecting aneurysms (DA). However, the incidence, risk factors and outcomes of CeAD patients with DA is not well established. This study aims to identify risk factors for developing DA, subsequent growth, and impact on patient outcomes. Methods: This is a secondary analysis of the Antithrombotics for Stroke Prevention in Cervical Artery Dissection (STOP-CAD), a multicenter cross-sectional international retrospective study. CeAD patients were stratified for the presence of DA. We used multivariable regression to identify factors associated with DA. Patients with DA were further analyzed for DA growth. The primary outcome was ischemic stroke after CeAD+DA diagnosis. Secondary outcomes included ischemic stroke after CeAD+DA with DA growth. Multivariable logistic regression analysis was used to assess the association between DA and risk factors. We also performed univariate Cox regression and generated Kaplan-Meier survival curves comparing study outcomes based on presence of DA and subsequent growth. Results: Of the 4023 patients included in the STOP-CAD study, 4008 were included in this analysis and 767 (19%) patients had DA (546 with DA on initial presentation). Patients with DA had a mean age of 46 [IQR 37-55] years and 50% (383) were women. In combined adjusted analyses, DA patients were more often non-Hispanic (aOR 0.63, 95% CI 0.41-0.94, p<0.02), more commonly had a history of migraine (aOR 1.27, 95% CI 1.01-1.59, p=0.037), connective tissue disorder (aOR 2.02, 95% CI 1.22-3.36, p=0.007), minor neck trauma (aOR 1.70, 95% CI 1.29-2.26, p<0.001) and were more likely to present with ischemic stroke (aOR 1.73, 95% CI 1.05-2.87, p=0.031). DA growth was noted in 55 out of 546 (10%) patients with DA on presentation. There was no significant difference in the risk of ischemic stroke by day 180 in patients with DA (hazard ratio [HR] 0.92 [95% CI, 0.65-1.30]; P =0.63) or DA growth (HR 2.40, [95% CI, 0.79-7.24]; P =0.12). Conclusion: In this subanalysis of STOP-CAD, nearly one in five patients with CeAD developed a DA. Factors associated with a higher likelihood of DA included non-Hispanic ethnicity, history of migraine, connective tissue disorder, minor neck trauma, and ischemic stroke at presentation. DA diagnosis and DA growth did not impact the risk of subsequent ischemic stroke at 6 months.

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Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.dp029
Primary Topic
Intracranial Aneurysms: Treatment and Complications
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article
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article

Abstract DP029: Incidence, risk factors, aneurysm growth, and outcomes of cervical artery dissection patients with dissecting aneurysm: STOP-CAD subanalysis

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

Abstract DP029: Incidence, risk factors, aneurysm growth, and outcomes of cervical artery dissection patients with dissecting aneurysm: STOP-CAD subanalysis

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

Abstract

Background: Cervical artery dissection (CeAD) accounts for nearly 25% of all ischemic strokes in young adults. CeAD can lead to the development of dissecting aneurysms (DA). However, the incidence, risk factors and outcomes of CeAD patients with DA is not well established. This study aims to identify risk factors for developing DA, subsequent growth, and impact on patient outcomes. Methods: This is a secondary analysis of the Antithrombotics for Stroke Prevention in Cervical Artery Dissection (STOP-CAD), a multicenter cross-sectional international retrospective study. CeAD patients were stratified for the presence of DA. We used multivariable regression to identify factors associated with DA. Patients with DA were further analyzed for DA growth. The primary outcome was ischemic stroke after CeAD+DA diagnosis. Secondary outcomes included ischemic stroke after CeAD+DA with DA growth. Multivariable logistic regression analysis was used to assess the association between DA and risk factors. We also performed univariate Cox regression and generated Kaplan-Meier survival curves comparing study outcomes based on presence of DA and subsequent growth. Results: Of the 4023 patients included in the STOP-CAD study, 4008 were included in this analysis and 767 (19%) patients had DA (546 with DA on initial presentation). Patients with DA had a mean age of 46 [IQR 37-55] years and 50% (383) were women. In combined adjusted analyses, DA patients were more often non-Hispanic (aOR 0.63, 95% CI 0.41-0.94, p<0.02), more commonly had a history of migraine (aOR 1.27, 95% CI 1.01-1.59, p=0.037), connective tissue disorder (aOR 2.02, 95% CI 1.22-3.36, p=0.007), minor neck trauma (aOR 1.70, 95% CI 1.29-2.26, p<0.001) and were more likely to present with ischemic stroke (aOR 1.73, 95% CI 1.05-2.87, p=0.031). DA growth was noted in 55 out of 546 (10%) patients with DA on presentation. There was no significant difference in the risk of ischemic stroke by day 180 in patients with DA (hazard ratio [HR] 0.92 [95% CI, 0.65-1.30]; P =0.63) or DA growth (HR 2.40, [95% CI, 0.79-7.24]; P =0.12). Conclusion: In this subanalysis of STOP-CAD, nearly one in five patients with CeAD developed a DA. Factors associated with a higher likelihood of DA included non-Hispanic ethnicity, history of migraine, connective tissue disorder, minor neck trauma, and ischemic stroke at presentation. DA diagnosis and DA growth did not impact the risk of subsequent ischemic stroke at 6 months.

StrokeVol. 57(Suppl_1)
Boston University (US), Cedars-Sinai Medical Center (US), Hartford Hospital (US), Cleveland Clinic (US), Mayo Clinic (US), North Carolina State University (US), University of Lisbon (PT), University of Louisville (US), Medical University of South Carolina (US), University of Bridgeport (US), University of Tennessee Health Science Center (US), Duke University (US), University of Basel (CH), Cornell University (US), Brown University (US), Hadassah Medical Center (IL), Rhode Island Hospital (US), University Hospital of Bern (CH), University of Iowa Hospitals and Clinics (US), 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), North Carolina Clinical Research (US), Istituti di Ricovero e Cura a Carattere Scientifico (IT), 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), University of Memphis (US)
Openalex Percentile: Top 73%
Intracranial Aneurysms: Treatment and Complications
DOISourceOpenAlex
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