Artery Dissection In Patient Research Articles

Prognostic significance of pulsatile tinnitus in cervical artery dissection.

Our aim was to investigate whether pulsatile tinnitus (PT) in cervical artery dissection (CeAD) has prognostic significance. All CeAD patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) study with documentation of PT were analysed. The presence of PT was systematically assessed using a standardized questionnaire. Stroke severity at admission was defined according to the National Institutes of Health Stroke Scale (NIHSS). Excellent outcome after 3 months was defined as a modified Rankin Scale of 0-1. Sixty-three of 778 patients (8.1%) reported PT. PT+ patients presented less often with ischaemic stroke (41.3% vs. 63.9%, P < 0.001), more often with dissection in the internal carotid artery (85.7% vs. 64.2%, P = 0.001), less often with vessel occlusion (19.0% vs. 34.1%, P = 0.017) and more often with excellent outcome at 3 months (92.1% vs. 75.4%, P = 0.002). Logistic regression analysis identified PT as an independent predictor of excellent outcome after 3 months [odds ratio (OR) 3.96, 95% confidence interval (CI) 1.22-12.87] adjusted to significant outcome predictors NIHSS on admission (OR 0.82, 95% CI 0.79-0.86), Horner syndrome (OR 1.95, 95% CI 1.16-3.29) and vessel occlusion (OR 0.62, 95% CI 0.40-0.94) and to non-significant predictors age, sex, pain and location of CeAD. The presence of PT in CeAD is associated with a benign clinical course and predicts a favourable outcome.

Abstract WP321: Smartphone Application Iodine: A Novel Method for Screening and Identification of Specific Stroke Study Population

Background and Purpose: Stroke studies and trials frequently require identification and screening of specific stroke patients based on set selection criteria, missed by traditional methods that rely on physician reporting and discharge diagnosis codes. Our aim was to determine the utility of a smartphone application, Iodine, in screening and identifying cervical artery dissection (CAD) patients. Methods: Iodine is used to notify healthcare providers regarding specific patient populations for the purpose of process and quality improvement. Real-time patient data is sent to Iodine via feeds secured by encrypted virtual private network tunnels, and continuously evaluated against Iodine’s library of Alert rules. All communication between Iodine and users are encrypted, all data accesses are audited, and data is not stored on mobile devices, thereby ensuring Health Insurance Portability and Accountability Act compliance. CAD is an uncommon cause for stroke or TIA that can affect young patients without traditional risk factors. Recent advances in imaging, including MRI and CT angiogram, have led to more frequent identification of CAD. Based on the identification of the keyword “dissection” in all radiological reporting, we setup a notification to alert study investigators. These notifications were reviewed daily for enrollment in an ongoing prospective study COMPASS. These patients were compared with those identified by ICD-9 discharge diagnosis codes. Results: In a six month period between January 01, 2015 and June 30, 2015, 18 patients with CAD were identified through the Iodine out of 289 total dissection alerts. (Mean age ± SD = 57 ± 17, 50% male, 61% Caucasian, and 39% African American). Of these 18 patients, 3 died in-hospital and thus could not be identified using traditional methods. Of these, only 13 patients were identified through ICD-9 discharge diagnosis codes, out of 4683 total discharges. Iodine was found to have a significantly higher proportion of detecting CAD (χ2=146.1; p&lt;0.0001). Conclusions: We report real time screening and identification of CAD using Iodine, which appears to be superior to traditional methods. This method may be successfully applied for other disease conditions for consecutive study patient identification.

Occipital Bony Abnormality and Multiple Strokes in a Pediatric Patient: Case Report and Review of the Current Literature.

This study presents a case of a 15-year-old boy who had a right vertebral artery dissection with distal embolization from repeated trauma from an occipital bony spicule. The authors hypothesize that this bony spicule was contacting the left vertebral artery during head rotation, resulting in trauma to the vessel and formation of emboli which then showered distally, causing strokes in the posterior circulation of the brain. This specific phenomenon has previously been reported three times, only one of which was in pediatric literature. It is important for individuals to be aware of this rare anatomic cause of vertebral artery dissection in patients presenting with an odd constellation of symptoms related to strokes from vertebro-basilar system. Treatment options including early intervention with intravascular coil embolization are also discussed.

Helsinki experience on nonvitamin K oral anticoagulants for treating cervical artery dissection.

BackgroundCervical artery dissection (CeAD) patients with or without stroke are frequently treated with either antiplatelet agents or vitamin K antagonists (VKAs), but few data are reported on the use of nonvitamin K oral anticoagulants (NOACs).MethodsBetween November 2011 and January 2014, we recorded data from patients with a stroke due to vertebral (VAD) or internal carotid artery dissection (ICAD). Patients using oral anticoagulants were included in the study and were divided into two treatment groups: patients using NOACs and those using VKAs. Excellent outcome was defined on modified Rankin Scale (mRS) ≤1 at 6 months.ResultsOf 68 stroke patients (67% male; median age 45 [39–53]), six (8.8%; two with VAD and four with ICAD) were treated with NOACs: three with direct thrombin inhibitor dabigatran and three with direct factor Xa inhibitor rivaroxaban. National Institutes of Health Stroke Scale score at baseline was 4 (3–7) in the NOAC versus 2 (1–7) in the VKA groups. Complete recanalization at 6 months was seen in most patients in the NOAC (n = 5; 83%) and VKA (n = 34; 55%) groups. All the patients using NOACs had mRS ≤1 at 6 months and none had an intracerebral hemorrhage (ICH). In the VKA group most patients (n = 48; 77%) had mRS ≤1, one patient (1.7%) had an ICH and one died.ConclusionsIn this small, consecutive single-center patient sample treating ischemic stroke patients with CeAD with NOACs did not bring up safety concerns and resulted in similar, good outcomes compared to patients using VKAs.

Abstract 256: Baseline Characteristics and Selected Outcomes in Spontaneous Coronary Artery Dissection Patients: Comparison of Cardiac Rehabilitation Participants and Non-participants

Background: Randomized controlled trials and meta-analyses have demonstrated the benefits of cardiac rehabilitation (CR) in patients with acute myocardial infarction (AMI). Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of AMI. However, the benefit of CR has not been well studied in patients with SCAD. Purpose: Our objective was to compare the psychosocial and physiological characteristics and outcomes of CR in SCAD patients who participated in CR compared to those who did not. Methods: We performed a retrospective descriptive analysis of patients with angiographically confirmed SCAD enrolled in the Mayo Clinic SCAD Registry from January 2010 through December 2014 who had completed questionnaires (n=354). Demographics, clinical characteristics, Generalized Anxiety Disorder 7-Item Scale (GAD-7), Patient Health Questionnaire-9 (depression measure; PHQ-9), and details about participants’ CR participation and experience were collected via medical record review and questionnaires. Univariate analyses were performed to determine the differences between baseline characteristics and outcomes according to CR participation status. Results: Mean age of participants at time of SCAD was 46 ± 10 years; 95% were female. Seventy-six percent of participants participated in at least one CR session, and those users averaged 18 ± 12 sessions. A majority of CR participants reported physical and emotional benefits (82% and 75%, respectively). Of those who did not participate in CR, the primary reason was because their healthcare provider did not recommend CR (67%). Other reasons included inadequate transportation (12%), no insurance coverage (8%), cost (2%), no energy (2%), and being too ill (2%). On comparative analyses, CR participants had higher mean GAD-7 scores (4.9 vs. 3.9; p=0.03) and were more likely to increase their amount of exercise (p&lt;0.01). Conclusions: Despite the well-known benefits of CR, in this international registry, only 76% of SCAD patients participated. Lack of recommendation for CR by a health care provider was the primary reason patients did not participate. The majority of patients reported benefits from CR. Higher GAD-7 scores were associated with CR participation, an interesting result requiring further evaluation in a larger or prospective cohort.

SPONTANEOUS CORONARY ARTERY DISSECTION PATIENTS SIGNIFICANTLY MORE FIT THAN THE AVERAGE PATIENT REFERRED FOR EXERCISE STRESS TESTING

Spontaneous Coronary Artery Dissection (SCAD) patients represent a rare subgroup presenting with acute coronary syndrome (ACS) who are often younger with fewer comorbidities than the average coronary artery disease patient. It is also a condition that disproportionately affects women who appear to

Anemia in young patients with ischaemic stroke.

To investigate the association of anemia on admission with ischaemic stroke (IS), stroke severity and early functional outcome in patients with cervical artery dissection (CeAD) or with IS of other causes (non-CeAD-IS patients). The study sample comprised all patients from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) study without pre-existing disability and with documentation of stroke severity and hemoglobin (Hb) concentration on admission. Anemia was classified as mild (Hb < 12 g/dl in women and Hb < 13 g/dl in men) or moderate to severe (Hb < 10 g/dl in women and Hb < 11 g/dl in men). Stroke severity on admission was assessed with the National Institutes of Health Stroke Scale (NIHSS). Outcome after 3 months was assessed with the modified Rankin Scale (mRS-3mo). Unfavorable outcome was defined as mRS-3mo ≥ 3. Amongst 1206 study patients (691 CeAD and 515 non-CeAD), 87 (7.2%) had anemia, which was moderate to severe in 18 (1.5%) patients. Anemia was associated with female sex in both study samples, but no further associations with risk factors or comorbidities were observed. In CeAD patients, anemia was associated with occurrence of stroke (P = 0.042). In both study samples, anemic patients had more severe strokes (CeAD, P = 0.023; non-CeAD, P = 0.005). Functional outcome was not associated with anemia in general, but moderate to severe anemia was significantly associated with unfavorable outcome (P = 0.004). Anemia on admission was associated with stroke in CeAD patients and with more severe strokes in both study samples. Moderate to severe anemia may predict unfavorable outcome.

Clinical import of Horner syndrome in internal carotid and vertebral artery dissection.

To study the prognostic importance of Horner syndrome (HS) in patients with internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD). In this observational study, characteristics and outcome of patients with ICAD or VAD from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) database were analyzed. The presence of HS was systematically assessed using a standardized questionnaire. Patients with HS (HS+) were compared with HS- patients. Crude odds ratios (ORs) with 95% confidence intervals and ORs adjusted for age, sex, center, arterial occlusion, bilateral dissection, stroke severity, and type of antithrombotic treatment were calculated. We analyzed 765 patients (n = 496 with ICAD, n = 269 with VAD, n = 303 prospective, n = 462 retrospective). HS was present in 191 (38.5%) of the patients with ICAD and 36 (13.4%) of the patients with VAD (p < 0.001). HS+ ICAD patients presented less often with stroke or TIA (p < 0.001), less often had bilateral (p = 0.019) or occlusive (p = 0.001) dissections, and had fewer severe strokes (p = 0.041) than HS- ICAD patients. HS+ ICAD patients had a better functional 3-month outcome than those without HS (ORcrude = 4.0 [2.4-6.7]), and also after adjustment for outcome-relevant covariates (ORadjusted = 2.0 [1.1-4.0]). HS+ ICAD patients were less likely to have new strokes than HS- ICAD patients (p = 0.039). HS+ VAD patients more often had vessel occlusion (p = 0.014) than HS- patients but did not differ in any of the other aforementioned variables. In patients with ICAD, HS is an easily assessable marker that might indicate a more benign clinical course. HS had no prognostic meaning in patients with VAD.

Stroke in first‐degree relatives of patients with cervical artery dissection

Patients with ischaemic stroke (IS) caused by a spontaneous cervical artery dissection (CeAD) worry about an increased risk for stroke in their families. The occurrence of stroke in relatives of patients with CeAD and in those with ischaemic stroke attributable to other (non-CeAD) causes were compared. The frequency of stroke in first-degree relatives (family history of stroke, FHS) was studied in IS patients (CeAD patients and age- and sex-matched non-CeAD patients) from the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) database. FHS≤50 and FHS>50 were defined as having relatives who suffered stroke at the age of ≤50 or >50years. FHS≤50 and FHS>50 were studied in CeAD and non-CeAD IS patients and related to age, sex, number of siblings, hypertension, hypercholesterolemia, smoking and body mass index (BMI). In all, 1225 patients were analyzed. FHS≤50 was less frequent in CeAD patients (15/598=2.5%) than in non-CeAD IS patients (38/627=6.1%) (P=0.003; odds ratio 0.40, 95% confidence interval 0.22-0.73), also after adjustment for age, sex and number of siblings (P=0.005; odds ratio 0.42, 95% confidence interval 0.23-0.77). The frequency of FHS>50 was similar in both study groups. Vascular risk factors did not differ between patients with positive or negative FHS≤50. However, patients with FHS>50 were more likely to have hypertension and higher BMI. Relatives of CeAD patients had fewer strokes at a young age than relatives of non-CeAD IS stroke patients.

Characteristics and Outcomes of Patients With Multiple Cervical Artery Dissection

Little is known about factors contributing to multiple rather than single cervical artery dissections (CeAD) and their associated prognosis. We compared the baseline characteristics and short-term outcome of patients with multiple to single CeAD included in the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study. Among the 983 patients with CeAD, 149 (15.2%) presented with multiple CeAD. Multiple CeADs were more often associated with cervical pain at admission (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.10-2.30), a remote history of head or neck surgery (OR, 1.87; 95% CI, 1.16-3.00), a recent infection (OR, 1.71; 95% CI, 1.12-2.61), and cervical manipulation (OR, 2.23; 95% CI, 1.26-3.95). On imaging, cervical fibromuscular dysplasia (OR, 3.97; 95% CI, 2.04-7.74) and the presence of a pseudoaneurysm (OR, 2.91; 95% CI, 1.86-4.57) were more often seen in patients with multiple CeAD. The presence of multiple rather than single CeAD had no effect on functional 3-month outcome (modified Rankin Scale score, ≥3; 12% in multiple CeAD versus 11.9% in single CeAD; OR, 1.20; 95% CI, 0.60-2.41). In the largest published series of patients with CeAD, we highlighted significant differences between multiple and single artery involvement. Features suggestive of an underlying vasculopathy (fibromuscular dysplasia) and environmental triggers (recent infection, cervical manipulation, and a remote history of head or neck surgery) were preferentially associated with multiple CeAD.

Outcome of Cervicocranial Artery Dissection with Different Treatments: A Systematic Review and Meta-analysis

The purpose of this meta-analysis is to compare clinical outcomes between endovascular treatment and conservative treatment for cervicocranial artery dissection. Medline, Embase, and Cochrane Library databases were searched for studies comparing endovascular treatment versus conservative treatment for cervicocranial artery dissection patients. The period searched was from November 1994 to March 2013. Fifteen observational studies involving 442 cervicocranial artery dissection patients were found. Evaluated outcomes included rate of mortality, disability, and good recovery. The rebleeding rate in subarachnoid hemorrhage (SAH) patients was also recorded and compared. In general, patients who received endovascular treatment enjoyed a lower mortality rate than those who received conservative treatment (P = .02, odds ratio [OR]: .5, 95% confidence interval [CI]: .27-.90), especially patients having ruptured cervicocranial artery dissection (P = .002, OR: .32, 95% CI .15-.66) and dissecting aneurysms (P = .006, OR: .31, 95% CI .14-.71). Among SAH patients with a Hunt-Hess score of 3 or more, endovascular treatment decreased mortality significantly (P = .006, OR: .22, 95% CI .08-.65), whereas no significant differences between these 2 treatments occurred in patients having a Hunt-Hess score less than 3. Endovascular treatment yields a better outcome, with greater benefit in patients with ruptured cervicocranial artery dissection, dissecting aneurysms, and a Hunt-Hess score of 3 or more. Randomized controlled trials comparing these 2 therapeutic strategies are needed.

Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome

Spontaneous coronary artery dissection (SCAD) found typically in young females without classical coronary risk factors is thought to be a very rare cause of acute coronary syndrome (ACS). The prevalence of SCAD in ACS subjects has been unclear, probably due to the nature of coronary angiography. The aim of this study was to use optical coherence tomography (OCT) to investigate the prevalence of SCAD in ACS. This study consisted of 326 patients with ACS (with or without ST-segment elevation) who underwent OCT to explore the entire culprit artery. According to OCT findings, patients were divided into a SCAD, a plaque rupture (PR), and a non-SCAD/non-PR group. OCT revealed 13 (4.0%) SCADs and 160 (49.1%) plaque ruptures in ACS subjects. The percentage of females versus males was greater in the SCAD group (SCAD: 53.8% vs. PR: 20.0% vs. non-SCAD/non-PR: 23.5%, p=0.02) while no difference was observed in age (SCAD: 67.3±13.3 vs. PR: 66.5±11.1 vs. non-SCAD/non-PR: 67.0±10.5, p=0.90). The prevalence of dyslipidemia (SCAD: 30.8% vs. PR: 63.8% vs. non-SCAD/non-PR: 67.5%, p=0.03) and current smoking (SCAD: 7.7% vs. PR: 57.9% vs. non-SCAD/non-PR: 59.7%, p<0.01) were significantly lower in the SCAD group. SCAD is not a rare cause for ACS, especially in females without classical coronary risk factors.

Prognosis of spontaneous coronary artery dissection in patients with acute coronary syndrome

Prognosis of spontaneous coronary artery dissection in patients with acute coronary syndrome

Elevated peripheral leukocyte counts in acute cervical artery dissection

It has been suggested that inflammation may play a role in the development of cervical artery dissection (CeAD), but evidence remains scarce. A total of 172 patients were included with acute (<24h) CeAD and 348 patients with acute ischaemic stroke (IS) of other (non-CeAD) causes from the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study, and 223 age- and sex-matched healthy control subjects. White blood cell (WBC) counts collected at admission were compared across the three groups. Compared with healthy control subjects, CeAD patients and non-CeAD stroke patients had higher WBC counts (P<0.001). Patients with CeAD had higher WBC counts and were more likely to have WBC>10000/μl than non-CeAD stroke patients (38.4% vs. 23.0%, P<0.001) and healthy controls (38.4% vs. 8.5%, P<0.001). WBC counts were higher in CeAD (9.4±3.3) than in IS of other causes (large artery atherosclerosis, 8.7±2.3; cardioembolism, 8.2±2.8; small vessel disease, 8.4±2.4; undetermined cause, 8.8±3.1; P=0.022). After adjustment for age, sex, stroke severity and vascular risk factors in a multiple regression model, elevated WBC count remained associated with CeAD, as compared with non-CeAD stroke patients [odds ratio (OR)=2.56; 95% CI 1.60-4.11; P<0.001) and healthy controls (OR=6.27; 95% CI 3.39-11.61; P<0.001). Acute CeAD was associated with particularly high WBC counts. Leukocytosis may reflect a pre-existing inflammatory state, supporting the link between inflammation and CeAD.

Cervical artery dissection

To examine the import of prior cervical trauma (PCT) in patients with cervical artery dissection (CeAD). In this observational study, the presence of and the type of PCT were systematically ascertained in CeAD patients using 2 different populations for comparisons: 1) age- and sex-matched patients with ischemic stroke attributable to a cause other than CeAD (non-CeAD-IS), and 2) healthy subjects participating in the Cervical Artery Dissection and Ischemic Stroke Patients Study. The presence of PCT within 1 month was assessed using a standardized questionnaire. Crude odds ratios (ORs) with 95% confidence intervals (CIs) and ORs adjusted for age, sex, and center were calculated. We analyzed 1,897 participants (n = 966 with CeAD, n = 651 with non-CeAD-IS, n = 280 healthy subjects). CeAD patients had PCT in 40.5% (38.2%-44.5%) of cases, with 88% (344 of 392) classified as mild. PCT was more common in CeAD patients than in non-CeAD-IS patients (ORcrude 5.6 [95% CI 4.20-7.37], p < 0.001; ORadjusted 7.6 [95% CI 5.60-10.20], p < 0.001) or healthy subjects (ORcrude 2.8 [95% CI 2.03-3.68], p < 0.001; ORadjusted 3.7 [95% CI 2.40-5.56], p < 0.001). CeAD patients with PCT were younger and presented more often with neck pain and less often with stroke than CeAD patients without PCT. PCT was not associated with functional 3-month outcome after adjustment for age, sex, and stroke severity. PCT seems to be an important environmental determinant of CeAD, but was not an independent outcome predictor. Because of the characteristics of most PCTs, the term mechanical trigger event rather than trauma may be more appropriate.

Spontaneous Coronary Artery Dissection: Prevalence of Predisposing Conditions Including Fibromuscular Dysplasia in a Tertiary Center Cohort

We sought to evaluate the prevalence of fibromuscular dysplasia (FMD) and other predisposing conditions among spontaneous coronary artery dissection (SCAD) patients. Spontaneous coronary artery dissection is considered rare. However, we observed many young women with SCAD and concomitant FMD. Spontaneous coronary artery dissection patients were identified prospectively and retrospectively at Vancouver General Hospital over the past 6 years. Coronary angiograms were meticulously reviewed by 2 senior interventional cardiologists. Identified patients were contacted for prospective evaluation at our SCAD clinic, and screening for FMD of renal, iliac, and cerebrovascular arteries was performed with computed tomography angiography or magnetic resonance angiography, if not already screened during the index angiogram. Potential predisposing and precipitating conditions for SCAD were extracted from clinical history. We identified 50 patients with nonatherosclerotic SCAD from April 2006 to March 2012. Average age was 51.0 years, and almost all were women (98.0%). All presented with myocardial infarction (MI), 30.0% had ST-segment elevation, and 70.0% had non-ST-segment elevation MI. Only 1 was postpartum, and 2 were involved in intense isometric exercises. Emotional stress was reported in 26.0% before the MI. Twelve percent had >1 dissected coronary artery. Most SCAD patients had FMD of ≥1 noncoronary territory (86.0%): 25 of 43 (58.1%) renal, 21 of 43 (48.8%) iliac, and 20 of 43 (46.5%) cerebrovascular (6 of 43, 14.0% had intracranial aneurysm). Five had incomplete FMD screening. Nonatherosclerotic SCAD predominantly affects women, and most have concomitant FMD. We suspect these patients have underlying coronary FMD that predisposed them to SCAD, but this requires proof from histology or intracoronary imaging of the affected coronary arteries.

Predictors of Delayed Stroke in Patients with Cervical Artery Dissection

Stroke in patients with acute cervical artery dissection may be anticipated by initial transient ischemic or nonischemic symptoms. Identifying risk factors for delayed stroke upon cervical artery dissection. Cervical artery dissection patients from the multicenter Cervical Artery Dissection and Ischemic Stroke Patients study were classified as patients without stroke (n = 339), with stroke preceded by nonstroke symptoms (delayed stroke, n = 244), and with stroke at onset (n = 382). Demographics, clinical, and vascular findings were compared between the three groups. Patients with delayed stroke were more likely to present with occlusive cervical artery dissection (P < 0.001), multiple cervical artery dissection (P = 0.031), and vertebral artery dissection (P < 0.001) than patients without stroke. No differences were observed in age, smoking, arterial hypertension, hypercholesterolemia, migraine, body mass index, infections during the last week, and trauma during the last month, but patients with delayed stroke had less often transient ischemic attack (P < 0.001) and local signs (Horner syndrome and cranial nerve palsy; P < 0.001). Occlusive cervical artery dissection, multiple cervical artery dissection, and vertebral artery dissection were associated with an increased risk for delayed stroke. No other risk factors for delayed stroke were identified. Immediate cervical imaging of cervical artery dissection patients without ischemic stroke is needed to identify patients at increased risk for delayed ischemia.

A Novel Method for Transcranial Doppler Microembolic Signal Monitoring at the Vertebrobasilar Junction in Vertebral Artery Dissection Patients

Vertebral artery dissection (VAD) is one of the most important etiologies in young stroke patients. VAD causes ischemic stroke by embolism and transcranial Doppler (TCD) monitoring can detect microemboli originating from the dissection point as high intensity transient signals (HITS). We developed a simple but novel method of TCD monitoring at the vertebrobasilar junction in VAD patients. We placed a Welder TCD headband upside down on the patient's head and rotated it by 90°. Then we fixed a pulsed-wave 2-MHz TCD probe to the headband and put it on the suboccipital paramedian area of the patient. With a patient in the lateral decubitus position, the vertebrobasilar junction was identified at a depth of approximately 80 mm. We examined 11 patients with VAD and detected HITS in 2 patients (18%). In 1 patient HITS disappeared after heparinization, and in the other patient HITS disappeared after treatment with aspirin. All of 9 HITS-negative patients and 1 of 2 HITS-positive patients experienced no ischemic recurrence during hospitalization. We successfully detected HITS at the vertebrobasilar junction in VAD patients, which may lead not only to an appropriate choice of antithrombotic drugs but also to individual evaluation of early risk of ischemic recurrence.

Non-atherosclerotic causes of myocardial ischemia in adults encountered in our centre: A retrospective analysis

BackgroundWe routinely treat young patients with myocardial infarction with no conventional risk factors for atherosclerosis other than smoking. Angiogram in such patients usually shows either a recanalized artery or evidence of thrombus. We aimed at deciphering non atherosclerotic causes of ischemia at our centre. MethodsWe serially analyzed 1500 diagnostic angiograms done at our center over a period of one year, with all patients above eighteen years of age. A retrospective analysis of presentation, risk factors and treatment and outcome (when available) was done. ResultsCoronary artery thrombosis was most common cause ( 5 patients), followed by coronary artery dissection (3) and coronary artery embolisation (2) patients. Takayasu arteritis and anamoulus origin of coronary artery were other causes. ConclusionOur study suggests that coronary artery thrombosis is most common non atherosclerotic cause of myocardial infarction and may respond favorably to thrombolytic treatment.

Age-dependent differences in cervical artery dissection

The goal of this work was to explore age-dependent differences in cervical artery dissection (CeAD). This study is based on the Cervical Artery Dissection and Ischemic Stroke Patients population comprising 983 consecutive CeAD patients and 658 control patients with a non-CeAD ischemic stroke (IS), frequency-matched for age and gender. Patients were divided into three age categories: ≤33 (for CeAD, n = 150), 34-54 (n = 688), and ≥55 (n = 145) years, and the youngest and oldest groups were compared. The youngest patients were mostly women and the oldest men. The frequency of internal carotid artery dissection (ICAD) versus vertebral artery dissection (VAD) increased with age from 44 to 75 %. This age-related shift remained significant after adjustment for sex. The frequency of a transient ischemic event as the CeAD symptom declined from 33 % in the youngest age group, to 19 % in the oldest. Vascular risk factors increased in frequency with advancing age in both groups, but for hypertension the increase was steeper for non-CeAD IS patients. For CeAD patients, but not for patients with non-CeAD IS, preceding infection was more common in the oldest group. The youngest non-CeAD IS patients had better functional outcome (modified Rankin Scale 0-1) than the oldest, while the similar trend was not statistically significant among CeAD patients. Younger age seems to be associated with VAD and female gender, and older age with ICAD and male gender. Age-related changes in the frequencies of hypertension and recent infection were different between the CeAD and non-CeAD IS groups. Age does not seem to be an important outcome predictor in CeAD strokes.