Recurrence of cervical artery dissection: A systematic review and meta-analysis

 I was told I had a carotid dissection but never received an ultrasound while in the hospital to determine what should be done. Warfarin then aspirin were prescribed but no warnings to me on neck movement or the likely danger of another plaque rupture.So for three years until the carotid completely closed up I was a high risk of tearing it again which my incompetent? doctors never found or mentioned what I should do to prevent a recurrence. Of course that was 17 years ago, so maybe things have improved.

Recurrence of cervical artery dissection: A systematic review and meta-analysis

Elizabeth Lounsbury elounsbury@bluewaterhealth.ca, Naomi Niznick https://orcid.org/0000-0003-0935-9135, […], and Michel Shamy https://orcid.org/0000-0002-0085-6816+5View all authors and affiliations

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https://doi.org/10.1177/17474930231201434

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Abstract

Background and Purpose:

Cervical artery dissection (CAD) involving the carotid or vertebral arteries is an important cause of stroke in younger patients. The purpose of this systematic review is to assess the risk of recurrent CAD.

Methods:

A systematic review and meta-analysis was conducted on studies in which patients experienced radiographically confirmed dissections involving an extracranial segment of the carotid or vertebral artery and in whom CAD recurrence rates were reported.

Results:

Data were extracted from 29 eligible studies (n = 5898 patients). Analysis of outcomes was performed by pooling incidence rates with random effects models weighting by inverse of variance. The incidence of recurrent CAD was 4% overall (95% confidence interval (CI) = 3–7%), 2% at 1 month (95% CI = 1–5%), and 7% at 1 year in studies with sufficient follow-up (95% CI = 4–13%). The incidence of recurrence associated with ischemic events was 2% (95% CI = 1–3%).

Conclusions:

We found low rates of recurrent CAD and even lower rates of recurrence associated with ischemia. Further patient-level data and clinical subgroup analyses would improve the ability to provide patient-level risk stratification.

Introduction

Cervical artery dissection (CAD) refers to dissection of the carotid or vertebral artery in an extracranial segment. It is an important cause of stroke, particularly in young adults, in whom CAD is identified as the cause of stroke in 1 in 4 cases.¹ It has been associated with connective tissue disorders, hypertension, certain infections, major trauma, and physical activity (presumably due to mechanical trauma or stretching of the vessel).^1–3

In some instances, CAD can recur in the same or another vessel. The prospect of recurrence is perhaps of greatest concern to a young, otherwise healthy, and physically active patient who has sustained an initial CAD with good functional recovery, and who wishes to resume exercise or recreational activities. This question has clear ramifications on quality of life. Recommendations on return to activity are made at the discretion of the individual practitioner, as there are no evidence-based guidelines to inform this discussion. An accurate estimate of the likelihood of recurrent CAD would be a valuable tool in assisting health care providers and patients in making decisions on risk assessment when considering return to activity. While there are individual studies examining the incidence of recurrent CAD, these are limited by small sample size and high degree of variability between studies, thus limiting generalizability. No previous systematic review exists on this topic.

 

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