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 DeLodovici; Mauro 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

doi:10.1161/STROKEAHA.120.031579

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 journal › Article › peer-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 language	English
Pages (from-to)	821-829
Number of pages	9
Journal	Stroke
Volume	52
Issue number	3
DOIs	https://doi.org/10.1161/STROKEAHA.120.031579
Publication status	Published - Mar 2021

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10.1161/STROKEAHA.120.031579

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Bonacina, S., Grassi, M., Zedde, M., Zini, A., Bersano, A., Gandolfo, C., Silvestrelli, G., Baracchini, C., Cerrato, P., Lodigiani, C., Marcheselli, S., Paciaroni, M., Rasura, M., Cappellari, M., Del Sette, M., Cavallini, A., Morotti, A., Micieli, G., Lotti, E. M., ... Pezzini, A. (2021). Clinical Features of Patients With Cervical Artery Dissection and Fibromuscular Dysplasia. Stroke, 52(3), 821-829. https://doi.org/10.1161/STROKEAHA.120.031579

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

In: Stroke, Vol. 52, No. 3, 03.2021, p. 821-829.

Research output: Contribution to journal › Article › peer-review

Bonacina, S, Grassi, M, Zedde, M, Zini, A , Bersano, A, Gandolfo, C, Silvestrelli, G, Baracchini, C, Cerrato, P, Lodigiani, C , Marcheselli, S, Paciaroni, M, Rasura, M, Cappellari, M, Del Sette, M, Cavallini, A, Morotti, A, Micieli, G, Lotti, EM, DeLodovici, ML, Gentile, M, Magoni, M, Azzini, C, Calloni, MV, Giorli, E, Braga, M, La Spina, P, Melis, F, Tassi, R, Terruso, V, Calabrò, RS, Piras, V, Giossi, A, Locatelli, M, Mazzoleni, V, Pezzini, D, Sanguigni, S, Zanferrari, C, Mannino, M, Colombo, I, Dallocchio, C, Nencini, P, Bignamini, V, Adami, A, Magni, E, Bella, R, Padovani, A & Pezzini, A 2021, 'Clinical Features of Patients With Cervical Artery Dissection and Fibromuscular Dysplasia', Stroke, vol. 52, no. 3, pp. 821-829. https://doi.org/10.1161/STROKEAHA.120.031579

Bonacina, Sonia ; Grassi, Mario ; Zedde, Marialuisa ; Zini, Andrea ; Bersano, Anna ; Gandolfo, Carlo ; Silvestrelli, Giorgio ; Baracchini, Claudio ; Cerrato, Paolo ; Lodigiani, Corrado ; Marcheselli, Simona ; Paciaroni, Maurizio ; Rasura, Maurizia ; Cappellari, Manuel ; Del Sette, Massimo ; Cavallini, Anna ; Morotti, Andrea ; Micieli, Giuseppe ; Lotti, Enrico Maria ; DeLodovici, Maria Luisa ; Gentile, Mauro ; Magoni, Mauro ; Azzini, Cristiano ; Calloni, Maria Vittoria ; Giorli, Elisa ; Braga, Massimiliano ; La Spina, Paolo ; Melis, Fabio ; Tassi, Rossana ; Terruso, Valeria ; Calabrò, Rocco Salvatore ; Piras, Valeria ; Giossi, Alessia ; Locatelli, Martina ; Mazzoleni, Valentina ; Pezzini, Debora ; Sanguigni, Sandro ; Zanferrari, Carla ; Mannino, Marina ; Colombo, Irene ; Dallocchio, Carlo ; Nencini, Patrizia ; Bignamini, Valeria ; Adami, Alessandro ; Magni, Eugenio ; Bella, Rita ; Padovani, Alessandro ; Pezzini, Alessandro. / Clinical Features of Patients With Cervical Artery Dissection and Fibromuscular Dysplasia. In: Stroke. 2021 ; Vol. 52, No. 3. pp. 821-829.

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title = "Clinical Features of Patients With Cervical Artery Dissection and Fibromuscular Dysplasia",

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.",

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

year = "2021",

month = mar,

doi = "10.1161/STROKEAHA.120.031579",

language = "English",

volume = "52",

pages = "821--829",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

TY - JOUR

T1 - Clinical Features of Patients With Cervical Artery Dissection and Fibromuscular Dysplasia

AU - Bonacina, Sonia

AU - Grassi, Mario

AU - Zedde, Marialuisa

AU - Zini, Andrea

AU - Bersano, Anna

AU - Gandolfo, Carlo

AU - Silvestrelli, Giorgio

AU - Baracchini, Claudio

AU - Cerrato, Paolo

AU - Lodigiani, Corrado

AU - Marcheselli, Simona

AU - Paciaroni, Maurizio

AU - Rasura, Maurizia

AU - Cappellari, Manuel

AU - Del Sette, Massimo

AU - Cavallini, Anna

AU - Morotti, Andrea

AU - Micieli, Giuseppe

AU - Lotti, Enrico Maria

AU - DeLodovici, Maria Luisa

AU - Gentile, Mauro

AU - Magoni, Mauro

AU - Azzini, Cristiano

AU - Calloni, Maria Vittoria

AU - Giorli, Elisa

AU - Braga, Massimiliano

AU - La Spina, Paolo

AU - Melis, Fabio

AU - Tassi, Rossana

AU - Terruso, Valeria

AU - Calabrò, Rocco Salvatore

AU - Piras, Valeria

AU - Giossi, Alessia

AU - Locatelli, Martina

AU - Mazzoleni, Valentina

AU - Pezzini, Debora

AU - Sanguigni, Sandro

AU - Zanferrari, Carla

AU - Mannino, Marina

AU - Colombo, Irene

AU - Dallocchio, Carlo

AU - Nencini, Patrizia

AU - Bignamini, Valeria

AU - Adami, Alessandro

AU - Magni, Eugenio

AU - Bella, Rita

AU - Padovani, Alessandro

AU - Pezzini, Alessandro

PY - 2021/3

Y1 - 2021/3

N2 - 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.

AB - 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.

U2 - 10.1161/STROKEAHA.120.031579

DO - 10.1161/STROKEAHA.120.031579

M3 - Article

C2 - 33504192

VL - 52

SP - 821

EP - 829

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 3

ER -

Clinical Features of Patients With Cervical Artery Dissection and Fibromuscular Dysplasia

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