Abstract T MP33: Younger Age And Anticoagulation Are Risk Factors For Pseudoaneurysm In Cases Of Cervical Arterial Dissection

Abstract

Background: Cervical artery dissection (CAD) is a frequent cause of ischemic stroke and pseudoaneurysm (PA) formation is a common complication. There is limited literature on the risk factors for PA formation. In particular, the influence of specific medical therapy for CAD_antiplatelet versus anticoagulation_is unknown. We hypothesized that anticoagulation in the treatment of CAD is a risk factor for PA formation. Methods: We retrospectively reviewed 250 cases of CAD admitted to a single hospital between 2011 and 2014. A neuroradiologist diagnosed CAD and PA by CTA. We reviewed patient charts for several risk factors: antithrombotic therapy, associated trauma, subsequent stroke, and age. Outcome (resolution or growth at 3 months) and largest size (at any point in time) of PA was recorded. Statistics were non-parametric. Results: 35 patients had a diagnosis of CAD, PA, and follow-up vascular imaging at 3 months after onset. 27 patients presented concomitantly with CAD and PA; 8 patients later developed PA. Median patient age was 48 years, median PA length along longest axis was 8mm, 84% were treated with antiplatelets and 16% were treated with therapeutic anticoagulation. All patients treated with anticoagulation experienced PA growth versus 44% of those treated with antiplatelet agents (Fisher’s Exact p = 0.046). Younger age was also associated with PA growth (Wilcoxon rank sum test p = 0.0198) and there was a trend towards larger median pseudoaneurysm size in patients receiving anticoagulation (median size 17mm versus 5mm, p=0.09). Traumatic dissection and ischemic stroke were not associated with pseudoaneurysm development or size. Discussion: Our study finds that in the setting of CAD, treatment with anticoagulation and younger age are risk factors for PA growth; furthermore, patients on anticoagulation tend to have larger PAs. While the natural history of PAs is typically benign, many patients undergo invasive treatments and face the fear of other complications. Given the clinical equipoise surrounding CAD treatment, our findings may have important implications for patient care and should be replicated in a larger dataset.