{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:28:15Z","timestamp":1792578495373,"version":"4.5.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004955","name":"\u00d6sterreichische Forschungsf\u00f6rderungsgesellschaft","doi-asserted-by":"publisher","award":["898252"],"award-info":[{"award-number":["898252"]}],"id":[{"id":"10.13039\/501100004955","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004061","name":"Oesterreichische Nationalbank","doi-asserted-by":"publisher","award":["15644"],"award-info":[{"award-number":["15644"]}],"id":[{"id":"10.13039\/501100004061","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Innsbruck and Medical University of Innsbruck"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>Occlusive cervical artery dissection (CeAD) is associated with worse patient outcome. The net clinical benefit of acute revascularization measures has to be weighed against the likelihood of spontaneous recanalization. Our aim was to assess the hitherto un-addressed impact of spontaneous recanalization on stroke risk in patients with occlusive CeAD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>MRI verified CeAD patients with initially occlusive CeAD within cohort study that did not undergo acute revascularization measures were assessed. Follow-up data derived from clinical routine and study specific assessments. Outcomes of interest were occurrence of (i) recanalization and (ii) ischemic stroke upstream of CeAD-related occlusion. Adjusted logistic regression analysis addressed the impact of recanalization on said outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>97\/328 (29.6%) patients had occlusive CeAD and did not undergo acute revascularization treatment. Upon follow-up, 56\/97 (57.7%) showed spontaneous recanalization of initially occlusive CeAD. Female sex (OR 0.41[0.18, 0.97]; <jats:italic>P<\/jats:italic>\u2009=\u20090.043) and internal carotid artery dissection (OR 0.33[0.14, 0.78]; <jats:italic>P<\/jats:italic>\u2009=\u20090.012) were the only factors independently associated with recanalization. Within a median follow-up of 8.2 (1.58, 12.8) years, a total of 18\/97 (18.6%) patients suffered ischemic stroke upstream of the initially CeAD-affected vessel. After adjusting for confounders, spontaneous recanalization was independently associated with lower rates of cerebral ischemia upon follow-up (OR 0.28[0.09, 0.90]; <jats:italic>P<\/jats:italic>\u2009=\u20090.032), most notably also independent of type of antithrombotic treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Spontaneous recanalization in occlusive CeAD is associated with lower rates of stroke upon follow-up. These results indicate that persistent CeAD-related occlusion remains a risk-factor for recurrent ischemic events, thus calling for future trials addressing optimal medical treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>N\/A.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Guarantor<\/jats:title>\n            <jats:p>Lukas Mayer-Suess.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00415-025-13371-y","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T16:53:58Z","timestamp":1757609638000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of spontaneous recanalization of occlusive cervical artery dissection on risk of stroke"],"prefix":"10.1007","volume":"272","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2856-0101","authenticated-orcid":false,"given":"Lukas","family":"Mayer-Suess","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josefin E.","family":"Kaufmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Scherer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anel","family":"Karisik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malik","family":"Galijasevic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Mangesius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke Ruth","family":"Gizewski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Kiechl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Traenka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan T.","family":"Engelter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Knoflach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"13371_CR1","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1016\/S1474-4422(09)70084-5","volume":"8","author":"S Debette","year":"2009","unstructured":"Debette S, Leys D (2009) Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 8:668\u2013678. https:\/\/doi.org\/10.1016\/S1474-4422(09)70084-5","journal-title":"Lancet Neurol"},{"key":"13371_CR2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873211046475","volume":"6","author":"S Debette","year":"2021","unstructured":"Debette S, Mazighi M, Bijlenga P et al (2021) ESO guideline for the management of extracranial and intracranial artery dissection. Eur Stroke J 6:XXXIX\u2013LXXXVIII. https:\/\/doi.org\/10.1177\/23969873211046475","journal-title":"Eur Stroke J"},{"key":"13371_CR3","doi-asserted-by":"publisher","DOI":"10.31083\/j.rcm2301009","volume":"23","author":"L Mayer-Suess","year":"2022","unstructured":"Mayer-Suess L, Peball T, Komarek S et al (2022) Disparities between guideline statements on acute and post-acute management of cervical artery dissection. Rev Cardiovasc Med 23:9. https:\/\/doi.org\/10.31083\/j.rcm2301009","journal-title":"Rev Cardiovasc Med"},{"key":"13371_CR4","doi-asserted-by":"publisher","first-page":"2301","DOI":"10.1007\/s10072-020-04735-5","volume":"42","author":"M Romoli","year":"2021","unstructured":"Romoli M, Mosconi MG, Pierini P et al (2021) Reperfusion strategies in stroke due to isolated cervical internal carotid artery occlusion: systematic review and treatment comparison. Neurol Sci 42:2301\u20132308. https:\/\/doi.org\/10.1007\/s10072-020-04735-5","journal-title":"Neurol Sci"},{"key":"13371_CR5","doi-asserted-by":"publisher","first-page":"272","DOI":"10.5853\/jos.2022.03370","volume":"25","author":"C Traenka","year":"2023","unstructured":"Traenka C, Lorscheider J, Hametner C et al (2023) Recanalization therapies for large vessel occlusion due to cervical artery dissection: a cohort study of the EVA-TRISP collaboration. J Stroke 25:272\u2013281. https:\/\/doi.org\/10.5853\/jos.2022.03370","journal-title":"J Stroke"},{"key":"13371_CR6","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.048295","author":"JA Sousa","year":"2025","unstructured":"Sousa JA, Rodrigo-Gisbert M, Shu L et al (2025) Emergent carotid stenting during thrombectomy in tandem occlusions secondary to dissection: a STOP-CAD secondary study. Stroke. https:\/\/doi.org\/10.1161\/STROKEAHA.124.048295","journal-title":"Stroke"},{"key":"13371_CR7","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/S1474-4422(21)00044-2","volume":"20","author":"ST Engelter","year":"2021","unstructured":"Engelter ST, Traenka C, Gensicke H et al (2021) Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial. Lancet Neurol 20:341\u2013350. https:\/\/doi.org\/10.1016\/S1474-4422(21)00044-2","journal-title":"Lancet Neurol"},{"key":"13371_CR8","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1002\/ana.26886","volume":"95","author":"JE Kaufmann","year":"2024","unstructured":"Kaufmann JE, Gensicke H, Schaedelin S et al (2024) Toward individual treatment in cervical artery dissection: subgroup analysis of the TREAT-CAD randomized trial. Ann Neurol 95:886\u2013897. https:\/\/doi.org\/10.1002\/ana.26886","journal-title":"Ann Neurol"},{"key":"13371_CR9","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1001\/jamaneurol.2024.1141","volume":"81","author":"JE Kaufmann","year":"2024","unstructured":"Kaufmann JE, Harshfield EL, Gensicke H et al (2024) Antithrombotic treatment for cervical artery dissection: a systematic review and individual patient data meta-analysis. JAMA Neurol 81:630\u2013637. https:\/\/doi.org\/10.1001\/jamaneurol.2024.1141","journal-title":"JAMA Neurol"},{"key":"13371_CR10","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1161\/STROKEAHA.123.045731","volume":"55","author":"S Yaghi","year":"2024","unstructured":"Yaghi S, Shu L, Mandel D et al (2024) Antithrombotic treatment for stroke prevention in Cervical Artery Dissection: the STOP-CAD study. Stroke 55:908\u2013918. https:\/\/doi.org\/10.1161\/STROKEAHA.123.045731","journal-title":"Stroke"},{"key":"13371_CR11","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1159\/000093244","volume":"22","author":"A Arauz","year":"2006","unstructured":"Arauz A, Hoyos L, Espinoza C et al (2006) Dissection of cervical arteries: long-term follow-up study of 130 consecutive cases. Cerebrovasc Dis 22:150\u2013154. https:\/\/doi.org\/10.1159\/000093244","journal-title":"Cerebrovasc Dis"},{"key":"13371_CR12","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/s0150-9861(05)83147-5","volume":"32","author":"F Charbonneau","year":"2005","unstructured":"Charbonneau F, Gauvrit JY, Touze E et al (2005) Diagnosis and follow-up of cervical arterial dissections\u2013results of the SFNV-SFNR study. J Neuroradiol 32:255\u2013257. https:\/\/doi.org\/10.1016\/s0150-9861(05)83147-5","journal-title":"J Neuroradiol"},{"key":"13371_CR13","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1161\/01.str.21.4.528","volume":"21","author":"E Pozzati","year":"1990","unstructured":"Pozzati E, Giuliani G, Acciarri N, Nuzzo G (1990) Long-term follow-up of occlusive cervical carotid dissection. Stroke 21:528\u2013531. https:\/\/doi.org\/10.1161\/01.str.21.4.528","journal-title":"Stroke"},{"key":"13371_CR14","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.048215","author":"DM Mandel","year":"2025","unstructured":"Mandel DM, Shu L, Chang C et al (2025) Factors associated with stroke recurrence after initial diagnosis of cervical artery dissection. Stroke. https:\/\/doi.org\/10.1161\/STROKEAHA.124.048215","journal-title":"Stroke"},{"key":"13371_CR15","doi-asserted-by":"publisher","first-page":"e170","DOI":"10.1212\/WNL.0000000000008654","volume":"94","author":"C Traenka","year":"2020","unstructured":"Traenka C, Grond-Ginsbach C, Goeggel Simonetti B et al (2020) Artery occlusion independently predicts unfavorable outcome in cervical artery dissection. Neurology 94:e170\u2013e180. https:\/\/doi.org\/10.1212\/WNL.0000000000008654","journal-title":"Neurology"},{"key":"13371_CR16","doi-asserted-by":"publisher","DOI":"10.21037\/atm-20-3169","volume":"8","author":"L Mayer","year":"2020","unstructured":"Mayer L, Grams A, Freyschlag CF et al (2020) Management and prognosis of acute extracranial internal carotid artery occlusion. Ann Transl Med 8:1268. https:\/\/doi.org\/10.21037\/atm-20-3169","journal-title":"Ann Transl Med"},{"key":"13371_CR17","doi-asserted-by":"publisher","first-page":"e2047","DOI":"10.1212\/WNL.0000000000010710","volume":"95","author":"L Mayer-Suess","year":"2020","unstructured":"Mayer-Suess L, Pechlaner R, Barallobre-Barreiro J et al (2020) Extracellular matrix protein signature of recurrent spontaneous cervical artery dissection. Neurology 95:e2047\u2013e2055. https:\/\/doi.org\/10.1212\/WNL.0000000000010710","journal-title":"Neurology"},{"key":"13371_CR18","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1177\/03331024221079298","volume":"42","author":"L Mayer-Suess","year":"2022","unstructured":"Mayer-Suess L, Frank F, T\u00f6ll T et al (2022) Head\/neck pain characteristics after spontaneous cervical artery dissection in the acute phase and on a long-run. Cephalalgia 42:872\u2013878. https:\/\/doi.org\/10.1177\/03331024221079298","journal-title":"Cephalalgia"},{"key":"13371_CR19","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","volume":"370","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453\u20131457. https:\/\/doi.org\/10.1016\/S0140-6736(07)61602-X","journal-title":"Lancet"},{"key":"13371_CR20","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1177\/17474930231185032","volume":"18","author":"L Mayer-Suess","year":"2023","unstructured":"Mayer-Suess L, Dejakum B, Ratzinger G et al (2023) Clinical characteristics and outcome in expansive compared with steno-occlusive mural hematoma in spontaneous cervical artery dissection. Int J Stroke 18:1186\u20131192. https:\/\/doi.org\/10.1177\/17474930231185032","journal-title":"Int J Stroke"},{"key":"13371_CR21","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1007\/s00415-025-13166-1","volume":"272","author":"JE Kaufmann","year":"2025","unstructured":"Kaufmann JE, Mayer-Suess L, Seiffge D et al (2025) Management of cervical artery dissection: new evidence and future directions. J Neurol 272:426. https:\/\/doi.org\/10.1007\/s00415-025-13166-1","journal-title":"J Neurol"},{"key":"13371_CR22","doi-asserted-by":"publisher","first-page":"1612","DOI":"10.1212\/01.WNL.0000159548.45013.C1","volume":"64","author":"D Georgiadis","year":"2005","unstructured":"Georgiadis D, Lanczik O, Schwab S et al (2005) IV thrombolysis in patients with acute stroke due to spontaneous carotid dissection. Neurology 64:1612\u20131614. https:\/\/doi.org\/10.1212\/01.WNL.0000159548.45013.C1","journal-title":"Neurology"},{"key":"13371_CR23","doi-asserted-by":"publisher","first-page":"3772","DOI":"10.1161\/STROKEAHA.109.555953","volume":"40","author":"ST Engelter","year":"2009","unstructured":"Engelter ST, Rutgers MP, Hatz F et al (2009) Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke 40:3772\u20133776. https:\/\/doi.org\/10.1161\/STROKEAHA.109.555953","journal-title":"Stroke"},{"key":"13371_CR24","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209843","volume":"103","author":"L Shu","year":"2024","unstructured":"Shu L, Akpokiere F, Mandel DM et al (2024) Intravenous thrombolysis in patients with cervical artery dissection. Neurology 103:e209843. https:\/\/doi.org\/10.1212\/WNL.0000000000209843","journal-title":"Neurology"},{"key":"13371_CR25","doi-asserted-by":"publisher","first-page":"1864","DOI":"10.1212\/WNL.0b013e3181feae5e","volume":"75","author":"C Baracchini","year":"2010","unstructured":"Baracchini C, Tonello S, Meneghetti G, Ballotta E (2010) Neurosonographic monitoring of 105 spontaneous cervical artery dissections: a prospective study. Neurology 75:1864\u20131870. https:\/\/doi.org\/10.1212\/WNL.0b013e3181feae5e","journal-title":"Neurology"},{"key":"13371_CR26","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1161\/STROKEAHA.108.519694","volume":"40","author":"K Nedeltchev","year":"2009","unstructured":"Nedeltchev K, Bickel S, Arnold M et al (2009) R2-recanalization of spontaneous carotid artery dissection. Stroke 40:499\u2013504. https:\/\/doi.org\/10.1161\/STROKEAHA.108.519694","journal-title":"Stroke"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-025-13371-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-025-13371-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-025-13371-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T10:34:52Z","timestamp":1760524492000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-025-13371-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":26,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["13371"],"URL":"https:\/\/doi.org\/10.1007\/s00415-025-13371-y","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"18 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that there is no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"All analyses were approved by the local ethics committee at the Medical University Innsbruck and appropriate informed consent of patients who took part in the ProSect-Study was obtained (EK# 1240\/2018).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and informed consent"}}],"article-number":"627"}}