Abstract 100: Impact of Dissection Location on Subsequent Stroke Risk: A Nationwide Analysis

Introduction: Cervical artery dissection (CAD) is a frequent cause of acute ischemic stroke (AIS) in young adults. We conducted a nationwide study to investigate potential predictors for subsequent AIS following CAD.

Method: Adult patients diagnosed with non-traumatic CAD, and without any previous or concurrent stroke (2016-2020), were identified from the Nationwide Readmission Database using validated and standard ICD-10 CM codes. Significant demographic and clinical factors associated with 90-day AIS risk were identified through weighted survey univariate logistic regression followed by a multivariate Cox regression model.

Result: Among 13,905 CAD patients (mean age 54.6±0.2, 54.8% female), 215 (1.5%) had subsequent AIS within 90 days of discharge with the median stroke occurrence on day 8. Patients with AIS were significantly older (58.3±1.3 vs. 54.5±0.2, P =0.026), and more commonly had vertebral artery dissection (51.6% vs. 41.0%, P =0.046), and coronary artery disease (24.7% vs. 15.6%, P =0.019). After including all these significant variables, the vertebral artery location of the dissection emerged as the sole significant predictor of subsequent AIS (adjusted HR 1.64, 95% CI 1.07-2.50, P =0.022). A Kaplan-Meier curve validated these findings, showing a higher AIS risk with vertebral versus carotid artery dissections (Figure). Notably, other risk factors such as hyperlipidemia and hypertension lacked significant association with AIS.

Conclusion: Our study identifies vertebral artery dissection as a significant risk factor for 90-day AIS occurrence post CAD. This highlights the need for research into tailored management strategies for these patients to reduce stroke risk.