Associated risk factors of ischemic events for spontaneous cervical artery dissection

Abstract

This study sought to identify risk factors of ischemic events and predictors of outcome for spontaneous cervical artery dissection (sCAD). One hundred and sixty one patients diagnosed as sCAD were classified as patients with (n=77) and without (n=84) cerebral ischemia. Demographics, vascular risk factors and imaging features were compared between the two groups. Multivariate Cox regression analysis was performed to identify predictors of primary end-point events (all cause stroke and death) at follow-up. Patients with cerebral ischemia had a higher prevelence of hypertension and diabetes mellitus (62.3% vs 41.7%, 14.3% vs 6.2%, P<0.05). Patients with cerebral ischemia were more likely to present with stenosis (61.0% vs 23.8%, P<0.001) and less likely to present with aneurysmal dilatation (19.5% vs 44.0%, P<0.001) and double lumen (22.1% vs 38.1%, P<0.05). There was significant positive association of diabetes mellitus (odds ratio 3.095; 95% confidence interval, 1.273 to 7.524, P=0.013) and stenosis (odds ratio 4.335, 95% confidence interval, 2.123 to 8.854, P<0.001), and an inverse association of aneurysmal dilatation (odds ratio 0.429, 95% confidence interval, 0.198 to 0.930, P=0.032) with occurrence of ischemic events in patients with sCAD. At a mean follow-up of 16.0 months, overall incidence of primary end-point was 9.3% (n=15). Cox regression analysis showed cerebral ischemia at onset, arterial occlusion, obesity or overweightness were significant predictors of the primary endpoint. This study confirms that diabetes mellitus and arterial stenosis are risk factors of ischemic events for sCAD patients. Cerebral ischemia at onset, arterial occlusion, obesity or overweightness are predictors of primary endpoint at follow-up.