{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T05:36:50Z","timestamp":1777095410614,"version":"3.51.4"},"reference-count":14,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Cervical artery dissection (CeAD) may be limited to the extracranial extradural space or extend to the intradural space. Intradural extension can potentially increase the risk of stroke and subarachnoid hemorrhage. However, the factors associated with intradural extension and its impact on clinical outcome remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a secondary analysis of the STOP\u2010CAD observational, multi\u2010center study. Patients with CeAD and intradural extension (CeADid) were compared with those with pure CeAD extradural dissections (CeADed) using multiple regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 4,023 patients with CeAD, 534 (13.3%) had CeADid. In comparison to patients with CeADed, those with CeADid more often had clinical overt stroke or transient ischemic attack (TIA) at presentation, acute infarcts on imaging, a vertebral artery affected, and severe stenosis of the involved vessel (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for all). In contrast, carotid involvement and complete occlusions were more frequent in patients with CeADed (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for both). CeADid was associated with a shift in the distribution of scores on the modified Rankin Scale (mRS) toward worse functional outcome (odds ratio [OR]\u2009=\u20090.76, 95% confidence interval [CI]\u2009=\u20090.62\u20130.92) but the odds for favorable outcomes (mRS\u2009=\u20090\u20132) did not differ between the groups after appropriate adjustments on multivariate analysis. CeADid was independently associated with higher mortality at 180\u2009days on multivariate analysis (adjusted OR\u2009=\u20092.84, 95% CI\u2009=\u20091.50\u20135.38).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>CeADid is associated with more severe clinical presentation, a shift toward less favorable outcomes, and higher mortality rates. These findings suggest that CeADid may represent a high\u2010risk type of CeAD. ANN NEUROL 2026;99:1189\u20131197<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.78151","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T10:06:54Z","timestamp":1767866814000},"page":"1189-1197","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Intradural Extension of Extracranial Cervical Artery Dissection on Outcomes: A Secondary Analysis From the\n                    <scp>STOP<\/scp>\n                    \u2010\n                    <scp>CAD<\/scp>\n                    Study"],"prefix":"10.1002","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9902-7528","authenticated-orcid":false,"given":"Issa","family":"Metanis","sequence":"first","affiliation":[{"name":"Department of Neurology Hadassah Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9784-8475","authenticated-orcid":false,"given":"Liqi","family":"Shu","sequence":"additional","affiliation":[{"name":"Department of Neurology Brown University Medical Center  Providence RI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Favour","family":"Akpokiere","sequence":"additional","affiliation":[{"name":"Department of Neurology Brown University Medical Center  Providence RI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamza","family":"Jubran","sequence":"additional","affiliation":[{"name":"Department of Neurology Hadassah Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9484-4698","authenticated-orcid":false,"given":"Daniel M.","family":"Mandel","sequence":"additional","affiliation":[{"name":"Department of Neurology West Virginia University School of Medicine  Morgantown WV USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian H.","family":"Nolte","sequence":"additional","affiliation":[{"name":"Department of Neurology and Center for Stroke Research Berlin (CSB) Charite \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James E.","family":"Siegler","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Chicago  Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan T.","family":"Engelter","sequence":"additional","affiliation":[{"name":"Department Rehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER University of Basel; Neurology and Stroke Center, University Hospital Basel, Department of Clinical Research, University Basel  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Mac Grory","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ophthalmology, and Biomedical Engineering Duke University School of Medicine; Duke Clinical Research Institute  Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0719-2522","authenticated-orcid":false,"given":"Jennifer","family":"Frontera","sequence":"additional","affiliation":[{"name":"NYU Grossman School of Medicine  New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhib","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic \u2013 Rochester  Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Rothstein","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital of the University of Pennsylvania  Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoel","family":"Schwartzmann","sequence":"additional","affiliation":[{"name":"Department of Neurology Hadassah Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Pedro","family":"Marto","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Egas Moniz, ULS Lisboa Ocidental and NOVA Medical School NOVA University  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marialuisa","family":"Zedde","sequence":"additional","affiliation":[{"name":"Neurology Unit, Stroke Unit, AUSL\u2010IRCCS di  Reggio Emilia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre Y.","family":"Poppe","sequence":"additional","affiliation":[{"name":"Department of Medicine (Neurology) Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al  Montreal, Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamer","family":"Jubeh","sequence":"additional","affiliation":[{"name":"Department of Neurology Hadassah Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zafer","family":"Keser","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic \u2013 Rochester  Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"AlMajali","sequence":"additional","affiliation":[{"name":"Ochsner Clinic Foundation  Covington LA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatma","family":"Shalabi","sequence":"additional","affiliation":[{"name":"Department of Neurology Hadassah Hebrew University Medical Center  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3883-5623","authenticated-orcid":false,"given":"Nils","family":"Henninger","sequence":"additional","affiliation":[{"name":"Department of Neurology Umass Chan Medical School  Worcester MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kateryna","family":"Antonenko","sequence":"additional","affiliation":[{"name":"Department of Neurology Inselspital University Hospital  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3594-2159","authenticated-orcid":false,"given":"Mirjam R.","family":"Heldner","sequence":"additional","affiliation":[{"name":"Department of Neurology Inselspital University Hospital  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Rosa","sequence":"additional","affiliation":[{"name":"Lisbon Central University Hospital \u2010 ULS  S\u00e3o Jos\u00e9, Lisbon Portugal"},{"name":"Faculdade de Medicina, Universidade de Lisboa  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ossama","family":"Khazaal","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital of the University of Pennsylvania  Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7744-2796","authenticated-orcid":false,"given":"Josefine","family":"E. 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