Abstract 99: Early Anticoagulation or Antiplatelet Therapy is Critical in Cranio-Cervical Artery Dissection: Results From the COMPASS Registry

Abstract

Introduction: Craniocervical artery dissection (CeAD) is a leading cause of stroke in the young. Recent studies reported a low rate of major adverse cardiac events (MACE) in patients with CeAD, with no significant difference between patients randomized to antiplatelet or anticoagulation. Methods: All patients from 2015-2017 consecutively identified by an electronic medical record-based application were enrolled in this prospective longitudinal registry. CeAD was confirmed by imaging and graded using the Denver scale for blunt cerebrovascular injury. Patients were followed for 12 months for MACE (stroke/transient ischemic attack [TIA]/death). Results: The cohort included 111 CeAD patients, (age 53 ±15.9 years, 56% white, 50% female) detected by magnetic resonance (5%), computed tomography (88%) and catheter (7%) angiography. CeAD was noted in the carotid (66%), vertebral (42%) and basilar (2%) arteries, with 83% of them being extracranial. CeAD was classified as grade 1, 2, 3 and 4 in 16%, 33%, 19%, and 32%, respectively. A total of 40% of dissections were due to known trauma. A predisposing factor was noted in the majority (78%), including 21% violent sneezing, 19% carrying heavy load, 11% sports/recreation activity, 9% chiropractic manipulation, 9% abrupt/prolonged rotation of head, and 9% prolonged phone use. At presentation, 41% had stroke, 39% had headache, 5% had TIA, and 15% were asymptomatic. Favorable outcome defined as modified Rankin score of 0-2 was noted in 68% at 3 months and 71% at 12 months. Rate of MACE was 14%, with more events observed in patients not on antiplatelet/anticoagulant therapy due to contraindications (p=0.008, Fig 1). Conclusions: We report diagnostic characteristics and short- and long-term outcomes of CeAD. A high MACE rate was observed within the first week of CeAD diagnosis, especially in patients not initiated on antiplatelet/anticoagulant therapy.