Vascular Imaging Features and Time-Specific Recurrence Risk After Craniocervical Artery Dissection

BACKGROUND AND OBJECTIVES: Craniocervical artery dissection (CCAD) is a major cause of stroke in young adults, yet its recurrence risk remains poorly defined because of delayed enrollment in prior research. We aimed to determine the temporal distribution of recurrent ischemic stroke and evaluate whether dissection location or specific vascular morphologies are associated with recurrence risk across discrete time intervals after the index event. METHODS: This multicenter cohort study analyzed data from the nationwide CRCS-K-NIH registry in South Korea (2011-2021). We included adult patients with acute ischemic stroke or TIA and CCAD diagnosed within 7 days of symptom onset (median onset-to-arrival time, 7.7 hours). The primary outcome was 1-year recurrent ischemic stroke. Recurrent events required MRI confirmation of new or extending infarction. Location (intracranial [I-CCAD] vs extracranial [E-CCAD]) and morphology (angiographic subtypes and features such as double lumen) were evaluated across 4 intervals (≤1, 2-3, 4-7, and >7 days). RESULTS: Among 75,903 hospitalized patients with acute ischemic stroke or TIA, 711 (0.94%) were diagnosed with CCAD. The mean age was 49.0 years, and 26.9% were women. I-CCAD accounted for 76.1% of cases. Recurrence was 8.7% on day 1, 17.4% within 1 week, and 19.9% at 1 year. Incidence rates declined steeply from 271.2 events per 1,000 person-days on day 1 to 0.1 beyond 7 days. Dissection location was not associated with recurrence risk. However, stenosis without dilatation (adjusted hazard ratio [aHR], 1.69 [95% CI 1.04-2.75]) and double lumen (aHR, 1.87 [95% CI 1.15-3.04]) were independently associated with higher 1-year recurrence risk. Double lumen sign was associated with recurrence between days 2 and 3 (adjusted incidence rate ratio, 3.84 [95% CI 1.67-8.81]). DISCUSSION: Stroke recurrence after CCAD is strongly clustered in the hyperacute phase. Early recurrence risk appeared to vary according to vascular morphology rather than anatomical location, with the presence of a double lumen demonstrating a distinct early temporal recurrence pattern. These findings support morphology-based, time-specific risk characterization to inform monitoring and secondary prevention strategies. Limitations include the retrospective design and restriction to an East Asian population.

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Journal
Neurology
Published
2026-09-18
DOI
https://doi.org/10.1212/wnl.0000000000218546
Primary Topic
Intracranial Aneurysms: Treatment and Complications
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article

Vascular Imaging Features and Time-Specific Recurrence Risk After Craniocervical Artery Dissection

Wook‐Joo Kim, Chan-Young Park, Jin Kyo Choi, Kyung‐Ho Yu et al.
Neurology
Intracranial Aneurysms: Treatment and Complications
article

Vascular Imaging Features and Time-Specific Recurrence Risk After Craniocervical Artery Dissection

Wook‐Joo Kim, Chan-Young Park, Jin Kyo Choi, Kyung‐Ho Yu, Dong‐Seok Gwak, Jihoon Kang, Hae-Bong Jeong, Hyung Seok Guk, Michelle Sojung Youn, Jee‐Hyun Kwon, Philip B. Gorelick, Nakhoon Kim, Mi Sun Oh, Jin‐Heon Jeong, Tai Hwan Park, Kwang‐Yeol Park, Keun‐Sik Hong, Ji Sung Lee, Soo Joo Lee, Jeong‐Ho Hong, Byung‐Chul Lee, Moon‐Ku Han, Han‐Gil Jeong, Sang‐Soon Park, Seong Hwa Jang, Chul‐Hoo Kang, Joong‐Goo Kim, Sung‐Il Sohn, Dong‐Eog Kim, Jae‐Kwan Cha, Dong‐Ick Shin, Kyu Sun Yum, Hee‐Joon Bae, Kang‐Ho Choi, Jay Chol Choi, Doo Hyuk Kwon, Stéphanie Debette, Jun Yup Kim, Hong‐Kyun Park, Chulho Kim, Hee-Yun Chae, Yong‐Jin Cho, Yong Soo Kim, Hyungjong Park, Dongwhane Lee, Jong‐Moo Park, Kyusik Kang, Juneyoung Lee, Minwoo Lee, Hyunsoo Kim, Jun Lee, Beom Joon Kim, Seong‐Eun Kim, Dae‐Hyun Kim, Sang‐Hwa Lee, Do Yeon Kim, Joon‐Tae Kim, Jae Guk Kim, Jeong‐Yoon Lee, Jonguk Kim, Kyung Bok Lee, Sangwon Choi, for the CRCS-K-NIH investigators, Jung Hwa Seo
article en

Abstract

BACKGROUND AND OBJECTIVES: Craniocervical artery dissection (CCAD) is a major cause of stroke in young adults, yet its recurrence risk remains poorly defined because of delayed enrollment in prior research. We aimed to determine the temporal distribution of recurrent ischemic stroke and evaluate whether dissection location or specific vascular morphologies are associated with recurrence risk across discrete time intervals after the index event. METHODS: This multicenter cohort study analyzed data from the nationwide CRCS-K-NIH registry in South Korea (2011-2021). We included adult patients with acute ischemic stroke or TIA and CCAD diagnosed within 7 days of symptom onset (median onset-to-arrival time, 7.7 hours). The primary outcome was 1-year recurrent ischemic stroke. Recurrent events required MRI confirmation of new or extending infarction. Location (intracranial [I-CCAD] vs extracranial [E-CCAD]) and morphology (angiographic subtypes and features such as double lumen) were evaluated across 4 intervals (≤1, 2-3, 4-7, and >7 days). RESULTS: Among 75,903 hospitalized patients with acute ischemic stroke or TIA, 711 (0.94%) were diagnosed with CCAD. The mean age was 49.0 years, and 26.9% were women. I-CCAD accounted for 76.1% of cases. Recurrence was 8.7% on day 1, 17.4% within 1 week, and 19.9% at 1 year. Incidence rates declined steeply from 271.2 events per 1,000 person-days on day 1 to 0.1 beyond 7 days. Dissection location was not associated with recurrence risk. However, stenosis without dilatation (adjusted hazard ratio [aHR], 1.69 [95% CI 1.04-2.75]) and double lumen (aHR, 1.87 [95% CI 1.15-3.04]) were independently associated with higher 1-year recurrence risk. Double lumen sign was associated with recurrence between days 2 and 3 (adjusted incidence rate ratio, 3.84 [95% CI 1.67-8.81]). DISCUSSION: Stroke recurrence after CCAD is strongly clustered in the hyperacute phase. Early recurrence risk appeared to vary according to vascular morphology rather than anatomical location, with the presence of a double lumen demonstrating a distinct early temporal recurrence pattern. These findings support morphology-based, time-specific risk characterization to inform monitoring and secondary prevention strategies. Limitations include the retrospective design and restriction to an East Asian population.

NeurologyVol. 107(7)
Northwestern University (US), Centre National de la Recherche Scientifique (FR), Inserm (FR), Korea University (KR), Eulji University (KR), Dong-A University Hospital (KR), Soonchunhyang University Hospital Seoul (KR), Asan Medical Center (KR), Seoul National University Bundang Hospital (KR), Sorbonne Université (FR), Sacred Heart Hospital (NG), Seoul Medical Center (KR), Chonnam National University Hospital (KR), Dongguk University Ilsan Hospital (KR), Inje University Ilsan Paik Hospital (KR), Ulsan University Hospital (KR), Sacred Heart Hospital (US), Yeungnam University Medical Center (KR), Catholic Kwandong University International St. Mary's Hospital (KR), Institut du Cerveau (FR), Chung-Ang University Hospital (KR), Hallym University Sacred Heart Hospital (KR), Chungbuk National University Hospital (KR), Jeju National University Hospital (KR), Keimyung University (KR), Jeju National University (KR)
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Intracranial Aneurysms: Treatment and Complications
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