Influencing factors and imaging features of young patients with ischemic stroke caused by cervicocerebral artery dissection

doi:10.3969/j.issn.1672-6731.2021.04.011

Abstract

Abstract:

Objective To explore the prevalence, influencing factors, and clinical and imaging features of cervicocerebral artery dissection (CAD) in young patients with ischemic stroke. Methods A total of 242 young patients with first ever ischemic stroke were included in this study from October 2016 to September 2020. Thirty-two patients with CAD were included in the CAD group, and 210 patients without CAD were included as controls. We collected the clinical and imaging data of all the patients. Univariate and multivariate Logistic regression analysis were used to screen the influencing factors of young ischemic stroke patients caused by CAD. And we analyzed imaging characteristics of CAD in different locations. Results Among the 242 young patients with ischemic stroke, 32 (13.22%) patients were due to CAD. Compared with the control group, the CAD group had younger onset age (t=-3.480, P=0.001), more inducible events (infection and neck movement) before the onset of cerebral infarction (t=8.796, P=0.003), and higher incidence of headache or neck pain (t=17.466, P=0.000) and posterior circulation infarction (t=22.705, P=0.000). Multivariate Logistic regression analysis showed that older age (OR=0.920, 95%CI: 0.853-0.992; P=0.030), the infarction located in the anterior circulation (OR=0.145, 95%CI: 0.059-0.356; P=0.000) were protective factors for ischemic stroke due to CAD, while head and neck pain (OR=5.428, 95%CI: 1.653-17.824; P=0.005) was risk factor for ischemic stroke due to CAD. The artery dissection lesions were located in anterior circulation in 11 (34.37%) patients with CAD, including 9 cases of extracranial carotid artery, one case of anterior cerebral artery, and one case of middle cerebral artery, while 21 (65.63%) patients' artery dissection lesions were located in the posterior circulation, including 10 cases of extracranial vertebral artery dissection (2 patients with bilateral lesions), 6 cases of intracranial segment, 4 cases with both intracranial and extracranial segment involvement, and one case with posterior inferior cerebellar artery dissection. After discharge, the follow-up imaging examination of 9 CAD patients showed that 6 patients had varying degrees of recovery of the arterial lumen and the rest 3 patients had no change. Conclusions CAD is a common cause of cerebral infarction in young people, and younger age, posterior circulation infarction and head and neck pain are risk factors for CAD.

Key words: Stroke, Brain ischemia, Intracranial arterial diseases, Carotid artery diseases, Logistic models, Magnetic resonance imaging, Young adult

摘要：

目的总结头颈部动脉夹层致青年缺血性卒中的发生率、相关影响因素及其临床和影像学特点。方法纳入2016年10月至2020年9月首都医科大学附属北京朝阳医院治疗的首发青年急性缺血性卒中患者共242例，根据病因分为头颈部动脉夹层组（CAD组，32例）和非头颈部动脉夹层组（对照组，210例），收集临床和影像学资料，采用单因素和多因素前进法Logistic回归分析筛查头颈部动脉夹层致青年缺血性卒中的影响因素，并归纳总结不同部位头颈部动脉夹层的影像学特点。结果头颈部动脉夹层占青年首发缺血性卒中的13.22%（32/242）。与对照组相比，CAD组患者年龄更小（t=-3.480，P=0.001），发病前多存在感染和颈部运动等诱因（t=8.796，P=0.003），存在头颈部疼痛比例更高（t=17.466，P=0.000），梗死部位位于前循环比例更低（t=22.705，P=0.000）。Logistic回归分析显示，年龄大（OR=0.920，95% CI：0.853~0.992；P=0.030）、梗死部位位于前循环（OR=0.145，95% CI：0.059~0.356；P=0.000）是头颈部动脉夹层致青年缺血性卒中的保护因素，而头颈部疼痛（OR=5.428，95% CI：1.653~17.824；P=0.005）是其危险因素。影像学检查显示夹层病变位于前循环11例（34.37%），包括颈动脉颅外段9例、大脑前动脉1例、大脑中动脉1例；位于后循环21例（65.63%），包括椎动脉颅外段10例（2例为双侧病变）、颅内段6例、颅内外均累及4例、小脑后下动脉1例。结论头颈部动脉夹层是青年缺血性卒中的常见病因，椎动脉夹层及后循环梗死更常见，年龄小、梗死部位位于后循环、头颈部疼痛是头颈部动脉夹层致青年缺血性卒中的危险因素。

关键词: 卒中, 脑缺血, 颅内动脉疾病, 颈动脉疾病, Logistic模型, 磁共振成像, 青年人

QIN Wei, YANG Lei, YANG Shu-na, LI Xuan-ting, LI Yue, JIANG Tao, HU Wen-li. Influencing factors and imaging features of young patients with ischemic stroke caused by cervicocerebral artery dissection[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(4): 296-303.

秦伟, 杨磊, 杨淑娜, 李譞婷, 李悦, 蒋涛, 胡文立. 头颈部动脉夹层致青年缺血性卒中影响因素及影像学特点分析[J]. 中国现代神经疾病杂志, 2021, 21(4): 296-303.

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References

[1] Engelter ST, Traenka C, Lyrer P. Dissection of cervical and cerebral arteries[J]. Curr Neurol Neurosci Rep, 2017, 17:59.
[2] Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, de Leeuw FE. Epidemiology, aetiology, and management of ischaemic stroke in young adults[J]. Lancet Neurol, 2018, 17:790-801.
[3] Chinese Society of Neurology of Chinese Medical Association, Chinese Stroke Society of Chinese Society of Neurology of Chinese Medical Association. Chinese guidelines for diagnosis and treatment of cervical artery dissection 2015[J]. Zhonghua Shen Jing Ke Za Zhi, 2015, 48:644-651.[中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国颈部动脉夹层诊治指南2015[J]. 中华神经科杂志, 2015, 48:644-651.]
[4] Neurointerventional Expert Committee of CCNS, Chinese Interventional Neuroradiology Society of CSA, Youth Committee of CCNS. Chinese expert consensus on imaging diagnosis of intracranial artery dissection[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2016, 32:1085-1094.[中国医师协会神经外科医师分会神经介入专家委员会, 中国卒中学会神经介入分会, 中国医师协会神经外科医师分会青年医师委员会. 颅内动脉夹层的影像学诊断中国专家共识[J]. 中华神经外科杂志, 2016, 32:1085-1094.]
[5] Li F, Yang L, Yang R, Xu W, Chen FP, Li N, Zhang JB. Ischemic stroke in young adults of Northern China:characteristics and risk factors for recurrence[J]. Eur Neurol, 2017, 77:115-122.
[6] Si Y, Xiang S, Zhang Y, Lu T, Guo J, Xiao X, Dong L. Clinical profile of aetiological and risk factors of young adults with ischemic stroke in West China[J]. Clin Neurol Neurosurg, 2020, 193:105753.
[7] Liu X, Jiang T, Li M, Zhang JY. High-resolution MRI in assessment of relationship of spontaneous cervicoce-rebral arterydissection and acute ischemic stroke[J]. Zhongguo Yi Xue Ying Xiang Ji Shu, 2020, 36:225-228.[刘潇, 蒋涛, 李敏,张继洋. 高分辨率MRI评估自发性头颈动脉夹层与缺血性卒中的关系[J]. 中国医学影像技术, 2020, 36:225-228.]
[8] Kim TW, Choi HS, Koo J, Jung SL, Ahn KJ, Kim BS, Shin YS, Lee KS. Intramural hematoma detection by susceptibility-weighted imaging in intracranial vertebral artery dissection[J]. Cerebrovasc Dis, 2013, 36:292-298.
[9] Wu Y, Wu F, Liu Y, Fan Z, Fisher M, Li D, Xu W, Jiang T, Cheng J, Sun B, Ji X, Yang Q. High-resolution magnetic resonance imaging of cervicocranial artery dissection:imaging features associated with stroke[J]. Stroke, 2019, 50:3101-3107.
[10] Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E, Kaste M, Tatlisumak T. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke:the Helsinki young stroke registry[J]. Stroke, 2009, 40:1195-1203.
[11] Ji R, Schwamm LH, Pervez MA, Singhal AB. Ischemic stroke and transient ischemic attack in young adults:risk factors, diagnostic yield, neuroimaging, and thrombolysis[J]. JAMA Neurol, 2013, 70:51-57.
[12] Garg A, Bathla G, Molian V, Limaye K, Hasan D, Leira EC, Derdeyn CP, Adams HP, Shaban A. Differential risk factors and outcomes of ischemic stroke due to cervical artery dissection in young adults[J]. Cerebrovasc Dis, 2020, 49:509-515.
[13] Nedeltchev K, der Maur TA, Georgiadis D, Arnold M, Caso V, Mattle HP, Schroth G, Remonda L, Sturzenegger M, Fischer U, Baumgartner RW. Ischaemic stroke in young adults:predictors of outcome and recurrence[J]. J Neurol Neurosurg Psychiatry, 2005, 76:191-195.
[14] Debette S, Compter A, Labeyrie MA, Uyttenboogaart M, Metso TM, Majersik JJ, Goeggel-Simonetti B, Engelter ST, Pezzini A, Bijlenga P, Southerland AM, Naggara O, Béjot Y, Cole JW, Ducros A, Giacalone G, Schilling S, Reiner P, Sarikaya H, Welleweerd JC, Kappelle LJ, de Borst GJ, Bonati LH, Jung S, Thijs V, Martin JJ, Brandt T, Grond-Ginsbach C, Kloss M, Mizutani T, Minematsu K, Meschia JF, Pereira VM, Bersano A, Touzé E, Lyrer PA, Leys D, Chabriat H, Markus HS, Worrall BB, Chabrier S, Baumgartner R, Stapf C, Tatlisumak T, Arnold M, Bousser MG. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection[J]. Lancet Neurol, 2015, 14:640-654.
[15] Madokoro Y, Sakurai K, Kato D, Kondo Y, Oomura M, Matsukawa N. Utility of T₁- and T₂- weighted high-resolution vessel wall imaging for the diagnosis and follow up of isolated posterior inferior cerebellar artery dissection with ischemic stroke:report of 4 cases and review of the literature[J]. J Stroke Cerebrovasc Dis, 2017, 26:2645-2651.
[16] Vidale S. Headache in cervicocerebral artery dissection[J]. Neurol Sci, 2020, 41(Suppl 2):395-399.
[17] Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, Pezzini A, Brandt T, Caso V, Touzé E, Metso A, Canaple S, Abboud S, Giacalone G, Lyrer P, Del Zotto E, Giroud M, Samson Y, Dallongeville J, Tatlisumak T, Leys D, Martin JJ; Cervical Artery Dissection Ischemic Stroke Patients (CADISP) Group. Differential features of carotid and vertebral artery dissections:the CADISP study[J]. Neurology, 2011, 77:1174-1181.
[18] Markus HS, Levi C, King A, Madigan J, Norris J; Cervical Artery Dissection in Stroke Study (CADISS). Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection:the Cervical Artery Dissection in Stroke Study (CADISS) randomized clinical trial final results[J]. JAMA Neurol, 2019, 76:657-664.
[19] Béjot Y, Aboa-Eboulé C, Debette S, Pezzini A, Tatlisumak T, Engelter S, Grond-Ginsbach C, Touzé E, Sessa M, Metso T, Metso A, Kloss M, Caso V, Dallongeville J, Lyrer P, Leys D, Giroud M, Pandolfo M, Abboud S; CADISP Group. Characteristics and outcomes of patients with multiple cervical artery dissection[J]. Stroke, 2014, 45:37-41.
[20] Compter A, Schilling S, Vaineau CJ, Goeggel-Simonetti B, Metso TM, Southerland A, Pezzini A, Kloss M, Touzé E, Worrall BB, Thijs V, Bejot Y, Reiner P, Grond-Ginsbach C, Bersano A, Brandt T, Caso V, Lyrer PA, Traenka C, Lichy C, Martin JJ, Leys D, Sarikaya H, Baumgartner RW, Jung S, Fischer U, Engelter ST, Dallongeville J, Chabriat H, Tatlisumak T, Bousser MG, Arnold M, Debette S; CADISP-plus Consortium. Determinants and outcome of multiple and early recurrent cervical artery dissections[J]. Neurology, 2018, 91:e769-780.
[21] Serkin Z, Le S, Sila C. Treatment of extracranial arterial dissection:the roles of antiplatelet agents, anticoagulants, and stenting[J]. Curr Treat Options Neurol, 2019, 21:48.

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