Clinical Features of Patients With Cervical Artery Dissection and Fibromuscular Dysplasia

Sonia Bonacina, Mario Grassi, Marialuisa Zedde, Andrea Zini, Anna Bersano, Carlo Gandolfo, Giorgio Silvestrelli, Claudio Baracchini, Paolo Cerrato, Corrado Lodigiani, Simona Marcheselli, Maurizio Paciaroni, Maurizia Rasura, Manuel Cappellari, Massimo Del Sette, Anna Cavallini, Andrea Morotti, Giuseppe Micieli, Enrico Maria Lotti, Maria Luisa DeLodoviciMauro Gentile, Mauro Magoni, Cristiano Azzini, Maria Vittoria Calloni, Elisa Giorli, Massimiliano Braga, Paolo La Spina, Fabio Melis, Rossana Tassi, Valeria Terruso, Rocco Salvatore Calabrò, Valeria Piras, Alessia Giossi, Martina Locatelli, Valentina Mazzoleni, Debora Pezzini, Sandro Sanguigni, Carla Zanferrari, Marina Mannino, Irene Colombo, Carlo Dallocchio, Patrizia Nencini, Valeria Bignamini, Alessandro Adami, Eugenio Magni, Rita Bella, Alessandro Padovani, Alessandro Pezzini

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND AND PURPOSE: Observational studies have suggested a link between fibromuscular dysplasia and spontaneous cervical artery dissection (sCeAD). However, whether patients with coexistence of the two conditions have distinctive clinical characteristics has not been extensively investigated.

METHODS: In a cohort of consecutive patients with first-ever sCeAD, enrolled in the setting of the multicenter IPSYS CeAD study (Italian Project on Stroke in Young Adults Cervical Artery Dissection) between January 2000 and June 2019, we compared demographic and clinical characteristics, risk factor profile, vascular pathology, and midterm outcome of patients with coexistent cerebrovascular fibromuscular dysplasia (cFMD; cFMD+) with those of patients without cFMD (cFMD-).

RESULTS: A total of 1283 sCeAD patients (mean age, 47.8±11.4 years; women, 545 [42.5%]) qualified for the analysis, of whom 103 (8.0%) were diagnosed with cFMD+. In multivariable analysis, history of migraine (odds ratio, 1.78 [95% CI, 1.13-2.79]), the presence of intracranial aneurysms (odds ratio, 8.71 [95% CI, 4.06-18.68]), and the occurrence of minor traumas before the event (odds ratio, 0.48 [95% CI, 0.26-0.89]) were associated with cFMD. After a median follow-up of 34.0 months (25th to 75th percentile, 60.0), 39 (3.3%) patients had recurrent sCeAD events. cFMD+ and history of migraine predicted independently the risk of recurrent sCeAD (hazard ratio, 3.40 [95% CI, 1.58-7.31] and 2.07 [95% CI, 1.06-4.03], respectively) in multivariable Cox proportional hazards analysis.

CONCLUSIONS: Risk factor profile of sCeAD patients with cFMD differs from that of patients without cFMD. cFMD and migraine are independent predictors of midterm risk of sCeAD recurrence.

Original languageEnglish
Pages (from-to)821-829
Number of pages9
JournalStroke
Volume52
Issue number3
DOIs
Publication statusPublished - Mar 2021

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