Sonia Bonacina1, Mario Grassi2, Marialuisa Zedde1, Andrea Zini3, Anna Bersano4, Carlo Gandolfo5, Giorgio Silvestrelli6, Claudio Baracchini7, Paolo Cerrato1, Corrado Lodigiani8, Simona Marcheselli9, Maurizio Paciaroni10, Maurizia Rasura11, Manuel Cappellari12, Massimo Del Sette13, Anna Cavallini14, Andrea Morotti15, Giuseppe Micieli16, Enrico Maria Lotti17, Maria Luisa DeLodovici18, Mauro Gentile3, Mauro Magoni19, Cristiano Azzini20, Maria Vittoria Calloni21, Elisa Giorli22, Massimiliano Braga23, Paolo La Spina24, Fabio Melis25, Rossana Tassi26, Valeria Terruso27, Rocco Salvatore Calabrò28, Valeria Piras29, Alessia Giossi30, Martina Locatelli1, Valentina Mazzoleni1, Debora Pezzini1, Sandro Sanguigni31, Carla Zanferrari32, Marina Mannino33, Irene Colombo34, Carlo Dallocchio35, Patrizia Nencini36, Valeria Bignamini37, Alessandro Adami38, Eugenio Magni39, Rita Bella40, Alessandro Padovani1, Alessandro Pezzini1. 1. Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Italy (S.B., M.L., V.M., D.P., A. Padovani, A. Pezzini). 2. Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Italy (M. Grassi). 3. IRCCS Istituto di Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy (A.Z., M. Gentile). 4. U.O. Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milano, Italy (A.B.). 5. Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Italy (C.G.). 6. Dipartimento di Neuroscienze, Stroke Unit, Ospedale Carlo Poma, Mantova, Italy (G.S.). 7. UOSD Stroke Unit e Laboratorio di Neurosonologia, Azienda Ospedale-Università di Padova, Italy (C.B.). 8. Centro Trombosi, IRCCS Humanitas Research Hospital, Rozzano-Milano, Italy (C.L.). 9. Neurologia d'Urgenza e Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano-Milano, Italy (S.M.). 10. Stroke Unit and Divisione di Medicina Cardiovascolare, Università di Perugia, Italy (M.P.). 11. Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università "La Sapienza," Roma, Italy (M.R.). 12. Stroke Unit, Azienda Ospedaliera Universitaria Integrata Borgo Trento, Verona, Italy (M.C.). 13. U.O. di Neurologia, Ospedale Galliera, Genova, Italy (M.D.S.). 14. UC Malattie Cerebrovascolari e Stroke Unit (A.C.), IRCCS Fondazione Istituto "C. Mondino," Pavia, Italy. 15. UO Neurologia, ASST della Valle Camonica, Esine, Italy (A.M.). 16. Neurologia d'Urgenza (G.M.), IRCCS Fondazione Istituto "C. Mondino," Pavia, Italy. 17. UOC Neurologia, AUSL Romagna, Ravenna, Italy (E.M.L.). 18. UO Neurologia, Ospedale di Circolo, Università dell'Insubria, Varese, Italy (M.L.D.). 19. Stroke Unit, Neurologia Vascolare, ASST Spedali Civili di Brescia, Italy (M. Magoni). 20. U.O. di Neurologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria di Ferrara (C.A.). 21. U.O. di Neurologia-Stroke Unit, Ospedale di Legnano, ASST-Ovest Milanese, Milano, Italy (M.V.C.). 22. Unità di Neurologia, Ospedale S. Andrea, La Spezia, Italy (E.G.). 23. UOC Neurologia, ASST Vimercate, Italy (M.B.). 24. UOSD Stroke Unit, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Italy (P.L.S.). 25. SS NeuroVascolare Ospedale Maria Vittoria, ASL Città di Torino, Italy (F.M.). 26. UOC Stroke Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy (R.T.). 27. UO Neurologia, Ospedale Villa Sofia, Palermo, Italy (V.T.). 28. Istituto di Ricovero e Cura a Carattere Scientifico, Centro Neurolesi Bonino-Pulejo, Messina, Italy (R.S.C.). 29. SC Neurologia e Stroke Unit, Dipartimento Neuroscienze e Riabilitazione, Azienda Ospedaliera "G. Brotzu," Cagliari, Italy (V.P.). 30. UO Neurologia, Istituti Ospitalieri, ASST Cremona, Italy (A.G.). 31. Dipartimento di Neurologia, Ospedale "Madonna del Soccorso," San Benedetto del Tronto, Italy (S.S.). 32. UOC Neurologia-Stroke Unit, ASST Melegnano-Martesana, PO Vizzolo Predabissi, Italy (C.Z.). 33. Stroke Unit, Ospedale Civico, Palermo, Italy (M. Mannino). 34. S.C. Neurologia e Unità Neurovascolare, Ospedale di Desio-ASST Monza, Italy (I.C.). 35. Dipartimento di Area Medica, UOC Neurologia, ASST Pavia, Voghera, Italy (C.D.). 36. Stroke Unit, Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy (P.N.). 37. Stroke Unit, UO Neurologia, Ospedale "S. Chiara," Trento, Italy (V.B.). 38. Stroke Center, Dipartimento di Neurologia, IRCSS Sacro Cuore Negrar, Verona, Italy (A.A.). 39. UO Neurologia, Istituto Ospedaliero Poliambulanza, Brescia, Italy (E.M.). 40. Dipartimento Di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, Sezione di Neuroscienze, Università di Catania, Italy (R.B.).
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.
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.
Authors: Marysia S Tweet; Jeffrey W Olin; Amanda R Bonikowske; David Adlam; Sharonne N Hayes Journal: Eur Heart J Date: 2021-10-01 Impact factor: 35.855