ABSTRACT NUMBER: ESOC2026A675 VASCULAR COURSE OF SPONTANEOUS CERVICAL ARTERY DISSECTION: INFLUENCE OF RECANALIZATION AND RECURRENCE ON CLINICAL OUTCOME

Abstract Background and aims To assess recanalization and recurrence of spontaneous cervical artery dissection and their influence on clinical outcome Methods Patients admitted to a TASC network hospital with a first-time spontaneous cervical artery dissection underwent recurrent duplex sonography up to 10 years to detect spontaneous arterial recanalization and dissection recurrence. The change of the functional outcome until 4.5 months after the dissecting index event served as secondary outcome parameter assessed by the mRS. Kaplan-Meier curves and Cox regression were used for statistical analyses. Results We included 159 patients with 191 spontaneous cervical artery dissections. Within 4 months, 40 of 80 initially occluded arteries recanalized (cumulative rate, 70%). Of 109 initially stenosed arteries, 84 normalized (cumulative rate, 98%). Intravenous thrombolysis and secondary prevention (anticoagulants vs. antiplatelet agents) were not associated with recanalization/normalization. Dissecting recurrence occurred in 15% of patients early (within 6 weeks) and 13.5% late (after 2 to 7 years). Neither spontaneous recanalization/normalization nor early dissecting recurrence predicted functional outcome which overall was well (median mRS 0; IQR 0 to 2). Worse outcome was associated with additional intracranial large artery occlusion (LAO) present in 25 patients (15.7%). Endovascular thrombectomy of intracranial LAO but not isolated (stent) angioplasty predicted better functional outcome within the whole patients’ cohort. Conclusions Neither spontaneous vascular recovery, which was common after cervical artery dissection, nor early dissecting recurrence, detected in up to 15% of patients, were independent outcome predictors. Worse outcome was predicted by additional intracranial LAO and can be improved by acute endovascular thrombectomy. Conflict of interest 1,4 Million Euros funding of the Telemedical Acute Stroke Care Network by the German Federal Ministry of Education and Research in 2011