Nicholas A Morris1, Alexander E Merkler2, Gino Gialdini1, Hooman Kamel1. 1. From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (N.A.M., A.E.M., G.G., H.K.) and Department of Neurology (A.E.M., H.K.), Weill Cornell Medicine, New York, NY; and Department of Neurology, Columbia University Medical Center, New York, NY (N.A.M.). 2. From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (N.A.M., A.E.M., G.G., H.K.) and Department of Neurology (A.E.M., H.K.), Weill Cornell Medicine, New York, NY; and Department of Neurology, Columbia University Medical Center, New York, NY (N.A.M.). alm9097@med.cornell.edu.
Abstract
BACKGROUND AND PURPOSE: Cervical artery dissection is a common cause of stroke in young people. The temporal profile of stroke risk after cervical artery dissection presenting without ischemia remains uncertain. METHODS: We performed a crossover cohort study using administrative claims data on all emergency department visits and acute care hospitalizations from 2005 to 2011 in CA, 2006 to 2013 in NY, and 2005 to 2013 in FL. Using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification codes, we identified patients with a cervical artery dissection and no previous or concurrent stroke or transient ischemic attack diagnosis. We compared the risk of stroke in successive 2-week periods during the 12 weeks after dissection versus the corresponding 2-week period 1 year later. Absolute risk increases were calculated using McNemar test for matched data. In a sensitivity analysis, we limited our population to patients presenting with typical symptoms of cervical artery dissection. RESULTS: We identified 2791 patients with dissection without ischemia. The absolute increase in stroke risk was 1.25% (95% confidence interval, 0.84-1.67%) in the first 2 weeks after dissection compared with the same time period 1 year later. The absolute risk increase was 0.18% (95% confidence interval, 0.02-0.34%) during weeks 3 to 4 and was no longer significant during the remainder of the 12-week postdissection period. Our findings were similar in a sensitivity analysis identifying patients who presented with typical symptoms of acute dissection. CONCLUSIONS: The risk of stroke after cervical artery dissection unaccompanied by ischemia at time of diagnosis seems to be limited to the first 2 weeks.
BACKGROUND AND PURPOSE: Cervical artery dissection is a common cause of stroke in young people. The temporal profile of stroke risk after cervical artery dissection presenting without ischemia remains uncertain. METHODS: We performed a crossover cohort study using administrative claims data on all emergency department visits and acute care hospitalizations from 2005 to 2011 in CA, 2006 to 2013 in NY, and 2005 to 2013 in FL. Using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification codes, we identified patients with a cervical artery dissection and no previous or concurrent stroke or transient ischemic attack diagnosis. We compared the risk of stroke in successive 2-week periods during the 12 weeks after dissection versus the corresponding 2-week period 1 year later. Absolute risk increases were calculated using McNemar test for matched data. In a sensitivity analysis, we limited our population to patients presenting with typical symptoms of cervical artery dissection. RESULTS: We identified 2791 patients with dissection without ischemia. The absolute increase in stroke risk was 1.25% (95% confidence interval, 0.84-1.67%) in the first 2 weeks after dissection compared with the same time period 1 year later. The absolute risk increase was 0.18% (95% confidence interval, 0.02-0.34%) during weeks 3 to 4 and was no longer significant during the remainder of the 12-week postdissection period. Our findings were similar in a sensitivity analysis identifying patients who presented with typical symptoms of acute dissection. CONCLUSIONS: The risk of stroke after cervical artery dissection unaccompanied by ischemia at time of diagnosis seems to be limited to the first 2 weeks.
Authors: Jennifer M DiCocco; Katrina P Emmett; Timothy C Fabian; Ben L Zarzaur; James S Williams; Martin A Croce Journal: Ann Surg Date: 2011-03 Impact factor: 12.969
Authors: Christian Weimar; Klaus Kraywinkel; Christoph Hagemeister; Anton Haass; Zaza Katsarava; Freimuth Brunner; Christian Haverkamp; Elisabeth Schmid; Hans-Christoph Diener Journal: J Neurol Neurosurg Psychiatry Date: 2010-08 Impact factor: 10.154
Authors: N Yesilot Barlas; J Putaala; U Waje-Andreassen; S Vassilopoulou; K Nardi; C Odier; G Hofgart; S Engelter; A Burow; L Mihalka; M Kloss; J Ferrari; R Lemmens; O Coban; E Haapaniemi; N Maaijwee; L Rutten-Jacobs; A Bersano; C Cereda; P Baron; L Borellini; C Valcarenghi; L Thomassen; A J Grau; F Palm; C Urbanek; R Tuncay; A Durukan Tolvanen; E J van Dijk; F E de Leeuw; V Thijs; S Greisenegger; K Vemmos; C Lichy; D Bereczki; L Csiba; P Michel; D Leys; K Spengos; H Naess; T Tatlisumak; S Z Bahar Journal: Eur J Neurol Date: 2013-07-10 Impact factor: 6.089
Authors: S Debette; C Grond-Ginsbach; M Bodenant; M Kloss; S Engelter; T Metso; A Pezzini; T Brandt; V Caso; E Touzé; A Metso; S Canaple; S Abboud; G Giacalone; P Lyrer; E Del Zotto; M Giroud; Y Samson; J Dallongeville; T Tatlisumak; D Leys; J J Martin Journal: Neurology Date: 2011-09-07 Impact factor: 9.910
Authors: Christopher Traenka; Henrik Gensicke; Sabine Schaedelin; Andreas Luft; Marcel Arnold; Patrik Michel; Georg Kägi; Timo Kahles; Christian H Nolte; Lars Kellert; Sverre Rosenbaum; Roman Sztaizel; Alex Brehm; Christoph Stippich; Marios Psychogios; Philippe Lyrer; Stefan T Engelter Journal: Eur Stroke J Date: 2020-06-29
Authors: Ava L Liberman; Babak B Navi; Charles C Esenwa; Cenai Zhang; Justin Song; Natalie T Cheng; Daniel L Labovitz; Hooman Kamel; Alexander E Merkler Journal: Stroke Date: 2020-04-16 Impact factor: 7.914
Authors: J Scott McNally; Peter J Hinckley; Akihiko Sakata; Laura B Eisenmenger; Seong-Eun Kim; Adam H De Havenon; Edward P Quigley; Eli Iacob; Gerald S Treiman; Dennis L Parker Journal: Stroke Date: 2018-10 Impact factor: 7.914
Authors: Eliza C Miller; Amelia K Boehme; Nadia T Chung; Sophia S Wang; James V Lacey; Kamakshi Lakshminarayan; Charlie Zhong; Daniel Woo; Natalie A Bello; Ronald Wapner; Mitchell S V Elkind; Joshua Z Willey Journal: Neurology Date: 2018-12-26 Impact factor: 11.800
Authors: Yahya B Atalay; Pirouz Piran; Abhinaba Chatterjee; Santosh Murthy; Babak B Navi; Ava L Liberman; Joseph Dardick; Cenai Zhang; Hooman Kamel; Alexander E Merkler Journal: Neurology Date: 2021-01-04 Impact factor: 9.910