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

• Main Authors: QIN Wei, YANG Lei, YANG Shu⁃na, LI Xuan⁃ting, LI Yue, JIANG Tao, HU Wen⁃li
• Format: Article
• Language: English
• Published: Tianjin Huanhu Hospital 2021-04-01
• Series: Chinese Journal of Contemporary Neurology and Neurosurgery
• Subjects: stroke; brain ischemia; intracranial arterial diseases; carotid artery diseases; logistic models; magnetic resonance imaging; young adult
• Online Access: http://www.cjcnn.org/index.php/cjcnn/article/view/2312

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. doi：10.3969/j.issn.1672⁃6731.2021.04.011