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dc.contributor.authorLarsson, SCen
dc.contributor.authorKing, Aen
dc.contributor.authorMadigan, Jen
dc.contributor.authorLevi, Cen
dc.contributor.authorNorris, JWen
dc.contributor.authorMarkus, Hughen
dc.date.accessioned2017-03-14T09:41:25Z
dc.date.available2017-03-14T09:41:25Z
dc.date.issued2017-02-14en
dc.identifier.issn0028-3878
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/263072
dc.description.abstract$\textbf{Objective:}$ To determine the natural history of dissecting aneurysm (DA) and whether DA is associated with an increased recurrent stroke risk and whether type of antithrombotic drugs (antiplatelets vs anticoagulants) modifies the persistence or development of DA. $\textbf{Methods:}$ We included 264 patients with extracranial cervical artery dissection (CAD) from the Cervical Artery Dissection in Stroke Study (CADISS), a multicenter prospective study that compared antiplatelet with anticoagulation therapy. Logistic regression was used to estimate age- and sex-adjusted odds ratios. We conducted a systematic review of published studies assessing the natural history of DA and stroke risk in patients with non-surgically-treated extracranial CAD with DA. $\textbf{Results:}$ In CADISS, DA was present in 24 of 264 patients at baseline. In 36 of 248 patients with follow-up neuroimaging at 3 months, 12 of the 24 baseline DAs persisted, and 24 new DA had developed. There was no association between treatment allocation (antiplatelets vs anticoagulants) and whether DA at baseline persisted at follow-up or whether new DA developed. During 12 months of follow-up, stroke occurred in 1 of 48 patients with DA and in 7 of 216 patients without DA (age- and sex-adjusted odds ratio 0.84; 95% confidence interval 0.10-7.31; $p$ = 0.88). Published studies, mainly retrospective, showed a similarly low risk of stroke and no evidence of an increased stroke rate in patients with DA. $\textbf{Conclusions:}$ The results of CADISS provide evidence suggesting that DAs may have benign prognosis and therefore medical treatment should be considered.
dc.description.sponsorshipCADISS was supported by a project grant from the Stroke Association. Recruitment was supported by the English National Institute for Health Research (NIHR) Stroke Research Network. Hugh Markus is supported by an NIHR Senior Investigator award and his work is supported by the Cambridge University Hospital Comprehensive Biomedical Research Centre.
dc.languageengen
dc.language.isoenen
dc.publisherWolters Kluwer
dc.subjectaneurysmsen
dc.subjectcervical artery dissectionen
dc.subjectstrokeen
dc.titlePrognosis of carotid dissecting aneurysms: Results from CADISS and a systematic reviewen
dc.typeArticle
prism.endingPage652
prism.issueIdentifier7en
prism.publicationDate2017en
prism.publicationNameNeurologyen
prism.startingPage646
prism.volume88en
dc.identifier.doi10.17863/CAM.8374
dcterms.dateAccepted2016-11-15en
rioxxterms.versionofrecord10.1212/WNL.0000000000003617en
rioxxterms.versionAMen
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2017-02-14en
dc.contributor.orcidMarkus, Hugh [0000-0002-9794-5996]
dc.identifier.eissn1526-632X
rioxxterms.typeJournal Article/Reviewen
cam.issuedOnline2017-01-13en
rioxxterms.freetoread.startdate2100-01-01


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