Article Impact Level: HIGH Data Quality: STRONG Summary of Neurology, 104(9), e213548. https://doi.org/10.1212/WNL.0000000000213548 Dr. Liqi Shu et al.
Points
- The study analyzed data from multiple sources to explore national trends in cervical artery dissection (CeAD) admissions and the subsequent risk of ischemic stroke (AIS) in patients with CeAD.
- The incidence of CeAD increased significantly from 10.7 cases per million in 2005 to 45.6 cases per million in 2019, with an average annual percent change of 10.21%.
- The upward trend in CeAD admissions was notably higher among older, Black, and Hispanic populations. State-level data supporting this national increase show an average annual percent change of 8.47%.
- Vertebral artery dissection was identified as a significant predictor of subsequent ischemic stroke, with a nearly two-fold increased risk of AIS within 90 days in patients with this condition.
- The study highlights the nearly five-fold increase in CeAD hospitalizations, likely due to better awareness and imaging. It stresses the need for targeted treatment and secondary prevention strategies in this high-risk group.
Summary
This study aimed to explore national trends in cervical artery dissection (CeAD) admissions and assess the subsequent risk of ischemic stroke (AIS) in patients with CeAD. Data from multiple sources were analyzed, including the National Inpatient Sample, National Readmission Database, and state-level databases from New York and Florida. The study identified 125,102 patients with spontaneous CeAD from 2005 to 2019, of whom 46.09% were female, and the mean age was 51.4 years. Over this period, the incidence of CeAD significantly increased from 10.7 cases per million population in 2005 to 45.6 cases per million population in 2019, representing an average annual percent change (AAPC) of 10.21% (95% CI, 9.67%–10.76%).
The upward trend in CeAD admissions was particularly pronounced among older, Black, and Hispanic populations, with state-level data corroborating this national increase, showing an AAPC of 8.47% (95% CI, 7.97%–9.48%). Among patients with CeAD but without concurrent AIS, vertebral artery dissection emerged as a significant predictor of subsequent ischemic stroke. Specifically, the adjusted subdistributed hazard ratio for AIS within 90 days in those with vertebral artery dissection was 1.77 (95% CI, 1.18–2.64, p = 0.006), highlighting the increased risk in this subgroup.
These findings suggest a nearly five-fold increase in CeAD hospitalizations between 2005 and 2019, likely driven by enhanced awareness and improved imaging techniques. Additionally, the study underscores the risk of subsequent ischemic stroke, especially in patients with vertebral artery dissection, which calls for targeted acute treatment and secondary prevention strategies. The study emphasizes the importance of further research to address treatment options and prevention in this patient population.
Link to the article: https://www.neurology.org/doi/10.1212/WNL.0000000000213548
References Shu, L., Strelecky, L., De Havenon, A., Nguyen, T. N., Henninger, N., Keser, Z., Khan, M., Siegler, J. E., Penckofer, M., Omran, S. S., Field, T. S., Zhou, L., Xiao, H., Jacobson, A., Goldstein, E. D., Stretz, C., Khan, F., Perelstein, E., Furie, K., & Yaghi, S. (2025). Incidence trends and risk of recurrent stroke of cervical artery dissections in the united states between 2005 and 2019. Neurology, 104(9), e213548. https://doi.org/10.1212/WNL.0000000000213548
