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Polyarterial clustered recurrence of cervical artery dissection seems to be the rule

From the Departments of Neurology (R.D., G.K., E.B.R.) and Clinical Radiology (I.N., R.B., D.M., W.H.), Leibniz Institute for Atherosclerosis Research (R.D., I.N., D.M., W.H., G.K., E.B.R.), University of Muenster; and Department of Neurology, Vivantes Klinikum Neukoelln (D.G.N.), Berlin, Germany.

Address correspondence and reprint requests to Dr. Ralf Dittrich, Department of Neurology, University Hospital of Muenster, Albert-Schweitzer-Strasse 33, 48129 Muenster, Germany dittrir{at}gmx.de

Background: Spontaneous cervical artery dissection (sCAD) in multiple neck arteries (polyarterial sCAD) is traditionally thought to represent a monophasic disorder suggesting nearly simultaneous occurrence of the various intramural hematomas. Its incidence ranges from 10 to 28%. The recurrence rate of sCAD in general over up to 8.6 years has been recorded to be 0 to 8%.

Objective: To analyze more precisely the temporal and spatial neuroangiologic course of sCAD with particular focus on polyarterial manifestation.

Methods: We prospectively investigated 36 consecutive patients with sCAD unexceptionally proven by MR imaging at 1.5 T. We reinvestigated these patients by two follow-up MR examinations. The first follow-up MR examination was performed after a mean of 16 ± 13 days, and the last MR study after a mean of 7 ± 2 months after the initial diagnosis.

Results: Systematic data evaluation of the 36 patients revealed the following phenomena of sCAD: 1) seemingly simultaneous polyarterial sCAD on the initial MRI scan (n = 2; 6%); 2) recurrent sCAD in one or several initially uninvolved cervical arteries during follow-up (n = 9; 25%). These latter sCAD occurred as an early polyarterial recurrent event within 1 to 4 weeks in 7 patients (19%), and as a delayed polyarterial recurrent event within 5 to 7 months in 2 patients (6%). Under a spatial perspective, sCAD recurrence took place in one additional cervical artery in 5 patients (14%), or in more than one previously uninvolved cervical artery in 4 patients (11%). All patients except one with sCAD recurrence remained asymptomatic or had local symptoms only. One patient experienced a significant clinical deterioration due to ischemic stroke with acute impairment of cerebral hemodynamics. During follow-up, patients received transient oral anticoagulation for at least 6 months with subsequent acetylsalicylic acid (ASA).

Conclusion: More often than previously thought, the recurrence of spontaneous cervical artery dissection (sCAD) involves multiple cervical arteries in sequence. sCAD recurrence frequently appears to cluster within the first 2 months after the index event, rather than occurring steadily over time. The prognosis of recurring sCAD appears benign, particularly in patients already receiving antithrombotic therapy.

*These authors contributed equally to the article.

Supported in part by the German ‘Competence Net Stroke’ which is supported by the German Federal Ministry of Education and Research (01GI9909/3).

Disclosure: The authors report no conflicts of interest.

Received September 11, 2006. Accepted in final form February 20, 2007.