Spontaneous Cervical Artery Dissection and Ischemic Stroke

Abstract

Abstract:

Spontaneous cervical artery dissection (SCAD) is one of the major cause of ischemic stroke in young and middle-aged patients. It is a multifactorial disease involving inheritance, environment, infection in which it is still controversy about the relationship between SCAD and vascular risk factors. Available evidence strongly favors embolism as the most common cause for ischemic stroke. Anticoagulation and antiplatelet are the main treatment options, but randomized trials are lacking to compare both options. There are several single-center studies to evaluate the validity and safety of endovascular stent therapy for SCAD. Most of SCAD has favorable prognosis.

Key words: Cervical artery dissection; Stroke, Ischemic; Vascular risk factors; Therapy

摘要：

自发性颈部动脉夹层（spontaneous cervical artery dissection，SCAD）是青中年缺血性卒中的主要病因之一。SCAD是遗传、环境、感染等多因素疾病，其中，血管相关危险因素与SCAD的关系仍然存在争论。研究显示，SCAD引起的缺血性卒中以血栓栓塞机制为主，因此，抗凝、抗血小板治疗是SCAD的主要治疗方式，但目前尚缺乏随机对照试验对两种治疗方式的疗效进行对比。同时，多项单中心病例研究证实了血管内支架治疗SCAD的有效性和安全性。

关键词: 颈部动脉夹层; 缺血性卒中; 血管危险因素; 治疗

LIU Juan, ZHOU Hua-Dong,LIU Juan, ZHOU Hua-Dong,. Spontaneous Cervical Artery Dissection and Ischemic Stroke[J]. Chinese Journal of Stroke, 2013, 8(10): 839-843.

刘娟，周华东，王延江，崔敏，李玲，许志强. 自发性颈部动脉夹层与缺血性卒中[J]. 中国卒中杂志, 2013, 8(10): 839-843.

References

1 Lee VH, Brown RD Jr, Mandrekar JN, et al. Incidence and outcome of cervical artery dissection:a population-based study[J]. Neurology, 2006, 67:1809-1812.

2 Caplan LR, Biousse V. Cervicocranial arterial dissections[J]. J Neuroophthalmol, 2004, 24:299-305.

3 Schievink WI. Spontaneous dissection of the carotid and vertebral arteries[J]. N Engl J Med, 2001, 344:898-906.

4 Kremer C, Mosso M, Georgiadis D, et al. Carotid dissection with permanent and transient occlusion or severe stenosis:long-term outcome[J]. Neurology, 2003, 60:271-275.

5 Nedeltchev K, der Maur TA, Georgiadis D, et al. Ischaemic stroke in young adults:Predictors of outcome and recurrence[J]. J Neurol Neurosurg Psychiatry, 2005, 76:191-195.

6 Micheli S, Paciaroni M, Corea F, et al. Cervical artery dissection:emerging risk factors[J]. Open Neurol J, 2010, 4:50-55.

7 Patel RR, Adam R, Maldjian C, et al. Cervical carotid artery dissection:current review of diagnosis and treatment[J]. Cardiol Rev, 2012, 20:145-152.

8 Longoni M, Grond-Ginsbach C, Grau AJ, et al. The ICAM-1 E469K gene polymorphism is a risk factor for spontaneous cervical artery dissection[J]. Neurology, 2006, 66:1273-1275.

9 Pezzini A, Caso V, Zanferrari C, et al. Arterial hypertension as risk factor for spontaneous cervical artery dissection:a case-control study[J]. J Neurol Neurosurg Psychiatry, 2006, 77:95-97.

10 Konrad C, Müller GA, Langer C, et al. Plasma homocysteine, MTHFR C677T, CBS 844 ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections[J]. J Neurol, 2004, 251:1242-1248.

11 Arnold M, Pannier B, Chabriat H, et al. Vascular risk factors and morphometric data in cervical artery dissection:a case-control study[J]. J Neurol Neurosurg Psychiatry, 2009, 80:232-234.

12 Guillon B, Berthet K, Benslamia L, et al. Infection and the risk of spontaneous cervical artery dissection:a case-control study[J]. Stroke, 2003, 34:e79-e81.

13 Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and pre-morbid risk-factor control:10-year results from the Oxford vascular study[J]. Circulation, 2003, 127:2031-2037.

14 Debette S, Metso T, Pezzini A, et al. Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults[J]. Circulation, 2011, 123:1537-1544.

15 Konrad C, Langer C, Müller GA, et al. Protease inhibitors in spontaneous cervical artery dissections[J]. Stroke, 2005, 36:9-13.

16 Baumgartner RW, Arnold M, Baumgartner I, et al. Carotid dissection with and without ischemic events:local symptoms and cerebral artery findings[J]. Neurology, 2001, 57:827-832.

17 Yaghi S, Maalouf N, Keyrouz SG. Cervical artery dissection:risk factors, treatment, and outcome:a 5-year experience from a tertiary care center[J]. Int J Neurosci, 2012, 122:40-44.

18 Kim YK, Schulman S. Cervical artery dissection: Pathology, epidemiology and management[J]. Int J Neurosci, 2009, 123:810-821.

19 Touzé E, Gauvrit JY, Moulin T, et al. Risk of stroke and recurrent dissection after a cervical artery dissection:a multicenter study[J]. Neurology, 2003, 61:1347-1351.

20 Baumgartner RW, Bogousslavsky J. Clinical manifestations of carotid dissection[J]. Front Neurol Neurosci, 2005, 20:70-76.

21 Morel A, Naggara O, Touzé E, et al. Mechanism of ischemic infarct in spontaneous cervicalartery dissection[J]. Stroke, 2012, 43:1354-1361.

22 Debette S, Grond-Ginsbach C, Bodenant M, et al. Differential features of carotid and vertebral artery dissections The CADISP Study[J]. Neurology, 2011, 77:1174-1181.

23 Georgiadis D, Lanczik O, Schwab S, et al. IV thrombolysis in patients with acute stroke due to spontaneous carotid dissection[J]. Neurology, 2005, 64:1612-1614.

24 Zinkstok SM, Vergouwen MD, Engelter ST, et al. Safety and functional outcome of thrombo-lysis in dissection-related ischemic stroke:A meta-analysis of individual patient data[J]. Stroke, 2011, 42:2515-2520.

25 Baumgartner RW. Management of spontaneous dissection of the cervical carotid artery[J]. Acta Neurochir Suppl, 2010, 107:57-61.

26 Lyrer PA. Extracranial arterial dissection: anticoagulation is the treatment of choice:against[J]. Stroke, 2005, 36:2042-2043.

27 Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection[J].Cochrane Database Syst Rev, 2003, (3):CD000255.

28 Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection[J]. Stroke, 2004, 35:613-614.

29 Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection[J]. Cochrane Database Syst Rev, 2010, (10):CD000255.

30 Cervical Artery Dissection in Stroke Study Trial Investigators. Antiplatelet therapy vs. anticoagulation in cervical artery dissection:rationale and design of the Cervical Artery Dissection in Stroke Study(CADISS)[J]. Int J Stroke, 2007, 2:292-296.

31 Müller BT, Luther B, Hort W, et al. Surgical treatment of 50 carotid dissections:indications and results[J]. J Vasc Surg, 2000, 31:980-988.

32 Biondi A, Katz JM, Vallabh J, et al. Progressive symptomatic carotid dissection treated with multiple stents[J]. Stroke, 2005, 36:e80-e82.

33 Donas KP, Mayer D, Guber I, et al. Endovascular repair of extracranial carotid artery dissection:current status and level of evidence[J]. J Vasc Interv Radiol, 2008, 19:1693-1698.

34 Schulte S, Donas KP, Pitoulias GA, et al. Endovascular treatment of iatrogenic and traumatic carotid artery dissection[J]. Cardiovasc Intervent Radiol, 2008, 31:870-874.

35 Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2011, 42:227-276.

36 Ohta H, Natarajan SK, Hauck EF, et al. Endovascular stent therapy for extracranial and intracranial carotid artery dissection:single-center experience[J]. J Neurosurg, 2011, 115:91-100.

37 Cohen JE, Gomori JM, Leker RR, et al. Recanalization of symptomatic carotid artery dissections causing occlusion with multiple stents:the use of delayed double-contrast road map[J]. Neurol Res, 2010, 32:293-296.

38 Cohen JE, Gomori JM, Itshayek E, et al. Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections[J]. J Trauma Acute Care Surg, 2012, 72:216-221.

39 Jeon P, Kim BM, Kim DI, et al. Emergent self-expanding stent placement for acute intracranial or extracranial internal carotid artery dissection with significant hemodynamic insufficiency[J]. AJNR Am J Neuroradiol, 2010, 31:1529-1532.

40 Taha MM, Sakaida H, Asakura F, et al. Endovascular management of vertebral artery dissecting aneurysms:review of 25 patients[J]. Turk Neurosurg, 2010, 20:126-135.

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