Abstract TP103: Vertebral Artery Tortuosity And Morphometric Characteristics In Recurrent Cervical Artery Dissection

Abstract

Background: Cervical Artery Dissection (CeAD) is an important cause of stroke in the young. Data on incidence and associations of recurrent CeAD are lacking. Increased Vertebral Artery Tortuosity Index (VTI) has been reported in patients with CeAD and associated with earlier age of arterial dissection in patients with connective tissue disease. We hypothesized that VTI may be associated with recurrent CeAD. Methods: We reviewed data from a large single-center registry of CeAD patients enrolled between 2011-2021. CT angiography (CTA) was reviewed for neck length, vertebral artery length (VAL), linear distance from the vertebral artery origin to the vertebrobasilar junction (VOBJ), and VTI [((VAL/VOBJ)–1)*100]. Recurrence was defined as radiographic diagnosis of a new dissection during a follow-up period between initial CTA imaging and July 1, 2021. Incidence rate of recurrent dissection was calculated using Poisson regression. Differences between groups were analyzed using the Kruskal-Wallis rank sum test and Fisher’s exact test. Results: The cohort included 155 patients: women (56%), mean (SD) age 42 (±10) years, and 116 single (carotid or vertebral) and 39 multiple artery dissections. Eight (5%) had a recurrence with a 10 year incidence rate (95% CI) of 1.23 events (0.53, 2.38) per 100 person-years. The recurrent group had a lower mean VTI than the nonrecurrent group (39.2 vs. 45.8; p = 0.024) and trended towards a lower mean age (34.6 vs. 42.3; p = 0.058). Participants with vertebral artery dissection were younger than those with carotid artery dissection with mean ages of 38.5 and 45.1 respectively (p < 0.001) and did not differ in mean VTI (46.0 vs. 44.9; p = 0.747). Morphometric characteristics of height, neck length, and BMI were not associated with recurrence. Conclusion: In this single center cohort of patients with CeAD, greater VTI was associated with a decreased risk of recurrent dissection. This finding is hypothesis generating as adults with recurrent dissections may have distinct mechanistic or genetic factors contributing to their risk of dissection. This study is limited by relatively small sample size and the retrospective analysis. Further study of VTI and risk of incident CeAD in larger independent cohorts is warranted.