Abstract WP170: Hospital Course And Clinical Outcomes In Internal Carotid Versus Vertebral Artery Dissections

Abstract

Background: Data regarding the differential clinical features of internal carotid artery dissection (CAD) versus vertebral artery dissection (VAD) are limited. We, therefore, aimed to evaluate the clinical course of cervical artery dissections (CeAD) presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA), according to the location of the dissection. Method: Hospitalizations with discharge diagnoses of CeAD and AIS/TIA were identified from the Nationwide Readmissions Database 2016-2018. Logistic regression analysis was used to compare the risk factors, interventions, and clinical outcomes of CAD and both CAD/VAD in reference to VAD alone. Survival analysis was used to study the risk of recurrent ischemic events after discharge. Results: There were 21402 hospitalizations with ischemic events due to CeAD (mean±SD age: 54.8±17.2 years, female: 40.7%). Of these, 10250 (47.9%) had VAD (reference group), 10813 (50.5%) had CAD, and 339 (1.6%) had both CAD/VAD. Patients with CAD were older, more likely to be female, more likely to have comorbidities like hypertension, atrial fibrillation, coronary artery disease, heart failure, tobacco use, head/neck vessel atherosclerosis, and previous stroke, and less likely to have migraines. Whereas patients with both CAD/VAD were younger, less likely to have hypertension, hyperlipidemia, and diabetes, and more likely to have Ehlers Danlos syndrome. Patients with CAD were more likely to receive intravenous thrombolysis and mechanical thrombectomy. Both groups had higher risk for intraparenchymal hemorrhage and in-hospital mortality and patients with CAD were less likely to discharge home as compared to those with VAD alone. Of 17925 patients with survival to discharge and known discharge disposition, 746 (4.2%) were readmitted due to recurrent ischemic events within 1 year of discharge (mean±SD time to readmission: 55.5±71.0 days). The risk of readmission did not vary by the location of dissection during the initial hospitalization. Conclusion: Carotid and vertebral artery dissections have different risk factor profiles. Although patients with CAD are more likely to get acute stroke interventions, they remain at a higher risk of worse clinical outcomes as compared to those with VAD.