{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:28:21Z","timestamp":1792578501874,"version":"4.5.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022. The primary outcome was subsequent ischemic stroke by day 180 after diagnosis. Clinical and imaging variables were compared between those with versus without subsequent ischemic stroke. Significant factors associated with subsequent stroke risk were identified using stepwise Cox regression. Associations between subsequent ischemic stroke risk and antithrombotic therapy type (anticoagulation versus antiplatelets) among patients with identified risk factors were explored using adjusted Cox regression.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              In all, 4023 patients (mean age was 47.4 years; 44.5% were women) were included. By day 180, subsequent ischemic stroke occurred in 5.3% of the cohort. In adjusted Cox regression, factors associated with increased risk of subsequent ischemic stroke were prior history of ischemic stroke (adjusted hazard ratio [aHR], 7.31 [95% CI, 1.61\u201333.13];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.010), presentation within 7 days from first symptoms (aHR, 3.04 [95% CI, 1.04\u20138.91];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.043), infarct on baseline imaging (aHR, 9.85 [95% CI, 3.65\u201326.58];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001), and occlusive dissection (aHR, 2.34 [95% CI, 1.03\u20135.34];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.043). Only patients with occlusive dissection demonstrated a reduced risk of subsequent ischemic stroke when treated with anticoagulation versus antiplatelets (aHR, 0.36 [95% CI, 0.16\u20130.80];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In this post hoc analysis of the STOP-CAD study, several factors associated with subsequent ischemic stroke were identified among patients with CAD. Furthermore, we identified a potential benefit of anticoagulation in patients with CAD with occlusive dissection. These findings require validation by meta-analyses of prior studies to formulate optimal treatment strategies for specific high-risk CAD subgroups.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.124.048215","type":"journal-article","created":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T09:08:00Z","timestamp":1743066480000},"page":"1413-1421","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection"],"prefix":"10.1161","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9484-4698","authenticated-orcid":true,"given":"Daniel M.","family":"Mandel","sequence":"first","affiliation":[{"name":"Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9784-8475","authenticated-orcid":true,"given":"Liqi","family":"Shu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5340-1608","authenticated-orcid":true,"given":"Naomi","family":"Jack","sequence":"additional","affiliation":[{"name":"Department of Neurology, Brown Medical School, Providence, RI (D.M.M., L.S., C.C., N.J., K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N. Mohammadzadeh, E.G., K.F., S. Yaghi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5997-5342","authenticated-orcid":true,"given":"Christopher R.","family":"Leon Guerrero","sequence":"additional","affiliation":[{"name":"Department of Neurology, Atrium Health, Charlotte, NC (C.R.L.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3883-5623","authenticated-orcid":true,"given":"Nils","family":"Henninger","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Massachusetts, Chan Medical School, Worcester, MA (N.H., J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3659-5862","authenticated-orcid":true,"given":"Jayachandra","family":"Muppa","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Massachusetts, Chan Medical School, Worcester, MA (N.H., J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Affan","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis (M. Affan, O.U.H.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omair","family":"Ul Haq Lodhi","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis (M. Affan, O.U.H.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3594-2159","authenticated-orcid":true,"given":"Mirjam R.","family":"Heldner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1936-5451","authenticated-orcid":true,"given":"Kateryna","family":"Antonenko","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-3849","authenticated-orcid":true,"given":"David","family":"Seiffge","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4274-4644","authenticated-orcid":true,"given":"Marcel","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3184-5327","authenticated-orcid":true,"given":"Setareh","family":"Salehi Omran","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O., R. Crandall, E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7911-9724","authenticated-orcid":true,"given":"Ross","family":"Crandall","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O., R. Crandall, E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Lester","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O., R. Crandall, E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5980-0166","authenticated-orcid":true,"given":"Diego","family":"Lopez Mena","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda Manuel Velasco Suarez, Mexico (D.L.M., A. Arauz)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3340-4138","authenticated-orcid":true,"given":"Antonio","family":"Arauz","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda Manuel Velasco Suarez, Mexico (D.L.M., A. Arauz)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Nehme","sequence":"additional","affiliation":[{"name":"Service de Neurologie, CHU Caen-Normandie, Universit\u00e9 Caen-Normandie, France (A.N., M.B., E.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0900-1766","authenticated-orcid":true,"given":"Marion","family":"Boulanger","sequence":"additional","affiliation":[{"name":"Service de Neurologie, CHU Caen-Normandie, Universit\u00e9 Caen-Normandie, France (A.N., M.B., E.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7254-2162","authenticated-orcid":true,"given":"Emmanuel","family":"Touz\u00e9","sequence":"additional","affiliation":[{"name":"Service de Neurologie, CHU Caen-Normandie, Universit\u00e9 Caen-Normandie, France (A.N., M.B., E.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5199-6210","authenticated-orcid":true,"given":"Joao Andre","family":"Sousa","sequence":"additional","affiliation":[{"name":"Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., V.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4665-5697","authenticated-orcid":true,"given":"Joao","family":"Sargento-Freitas","sequence":"additional","affiliation":[{"name":"Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., V.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2646-7300","authenticated-orcid":true,"given":"Vasco","family":"Barata","sequence":"additional","affiliation":[{"name":"Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., 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MN (M.K., Z.K., K.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania","family":"Mallick","sequence":"additional","affiliation":[{"name":"Department of Neurology, Corewell Health, Grand Rapids, MI (M.K., D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8480-8220","authenticated-orcid":true,"given":"Aaron","family":"Rothstein","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pennsylvania, Philadelphia (A.R., O.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8308-6596","authenticated-orcid":true,"given":"Ossama","family":"Khazaal","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pennsylvania, Philadelphia (A.R., O.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7744-2796","authenticated-orcid":true,"given":"Josefin E.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, and University Hospital Basel, Switzerland (J.E.K., S.T.E., C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3855-6234","authenticated-orcid":true,"given":"Stefan T.","family":"Engelter","sequence":"additional","affiliation":[{"name":"Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, and University Hospital Basel, Switzerland (J.E.K., S.T.E., C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7600-1005","authenticated-orcid":true,"given":"Christopher","family":"Traenka","sequence":"additional","affiliation":[{"name":"Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, and University Hospital Basel, Switzerland (J.E.K., S.T.E., C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6702-7924","authenticated-orcid":true,"given":"Diana","family":"Aguiar de Sousa","sequence":"additional","affiliation":[{"name":"Stroke Center, Centro Hospitalar Universit\u00e1rio Lisboa Central, and Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Portugal (D.A.d.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7508-0645","authenticated-orcid":true,"given":"Mafalda","family":"Soares","sequence":"additional","affiliation":[{"name":"Departments of Neurology (M. 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Mancini)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5764-9781","authenticated-orcid":true,"given":"Preet","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-0633","authenticated-orcid":true,"given":"Thalia S.","family":"Field","sequence":"additional","affiliation":[{"name":"Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Mancini","sequence":"additional","affiliation":[{"name":"Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. 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Choi, J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7494-7093","authenticated-orcid":true,"given":"Jason","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, ChristianaCare, Newark, DE (R. 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