Abstract Details

Title Spontaneous or Traumatic Cervical Artery Dissection: A Distinction with Therapeutic Impact

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 236

Objective

Background BACKGROUND: The literature broadly classifies CAD into two categories: spontaneous or traumatic. While the terminology is primarily based on history, more recent studies have tried to identify factors that distinguish them based on histological features, risk of ischemic complications, or recurrence risk. The best therapeutic options for each type are unclear.

Design/Methods DESIGN/METHODS: We systematically reviewed the medical literature through MEDLINE and PubMed between 1966 and 2012, with review of reference lists.

Results RESULTS: No definitive histological differences between spontaneous and traumatic CAD are known. Spontaneous CAD is rarely associated with connective tissue disease, with contribution from acquired risk factors such as hypertension and hyperlipidemia. Trauma ranges from minor hyperextension to polytrauma with severe injuries or coagulopathy. The definitions overlap: history of minor trauma is occasionally identified in presumed spontaneous CAD. The highest risk of distal embolism is within one month after dissection, and limited data suggest higher risks in traumatic cases. Overall annual recurrent embolic risk is about 2% in the first year and 1% thereafter. Observational data show no superiority between antiplatelet or anticoagulant therapy, in spontaneous CAD or combined analysis. No specific data is available regarding therapy in traumatic CAD. Whether a difference exists in recurrence risk between the groups is unknown.

Conclusions CONCLUSIONS: Few differences exist between spontaneous and traumatic CAD, and their risk factors can overlap. Major distinguishing factors are the embolic and hemorrhagic risks, and a balance of the two should be accounted for in treatment decision making, especially involving antithrombotic therapy. More data are necessary to devise a rationalized therapeutic approach based on this distinction.

Authors/Disclosures
Jenny P. Tsai, MD (The Ottawa Hospital - Civic Campus) PRESENTER	No disclosure on file
Richard H. Swartz, BSc MD PhD FRCPC (Sunnybrook Health Sciences Centre)	The institution of Dr. Swartz has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Swartz has received research support from Ontario Brain Institute.
Per Soelberg Sorensen	No disclosure on file

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