Almost 60% of patients with CeAD achieved complete vessel recanalization by 6 months, and older age, diabetes, smoking, and complete occlusion at presentation were independently associated with incomplete recanalization.
Key Findings
Results
About 58% of patients with single-vessel cervical artery dissection causing stenosis achieved complete recanalization within 6 months.
Among 1,095 included patients, 634 (57.9%) achieved complete recanalization by 6 months.
Median age was 45 years and 46.7% were female.
Data came from the Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection study, a multicenter retrospective cohort at 63 sites worldwide (diagnoses January 2015 to June 2022).
Only patients with single-vessel CeAD causing stenosis at presentation and vascular imaging at 6 months were included.
Results
Older age was independently associated with lower odds of complete recanalization.
Each additional year of age: OR 0.97 (95% CI 0.96-0.98; p < 0.001).
Determined by multivariable logistic regression.
Results
Diabetes and active smoking were independently associated with lower odds of complete recanalization.
Diabetes: OR 0.46 (95% CI 0.27-0.81; p = 0.006).
Active smoking: OR 0.69 (95% CI 0.50-0.95; p = 0.025).
Results
Complete occlusion at presentation was independently associated with lower odds of complete recanalization and with longer time to recanalization.
Complete occlusion at presentation: OR 0.44 (95% CI 0.32-0.59; p < 0.001).
Time to complete recanalization was analyzed using an accelerated failure time Weibull model, which showed longer time to recanalization with complete occlusion.
Results
Antithrombotic regimen (antiplatelet therapy vs anticoagulation) showed no effect on complete recanalization.
The authors reported observing no effect of antithrombotic regimen on complete recanalization.
This was a retrospective observational comparison.
Results
Incomplete recanalization was associated with a numerically higher, but nonsignificant, proportion of recurrent ischemic stroke.
Recurrent stroke occurred in 5.4% of patients with incomplete recanalization vs 3.5% with complete recanalization (p = 0.064).
Conclusions
The authors suggest the findings may inform tailored imaging surveillance and secondary prevention, but this needs further study.
Older age, diabetes, smoking, and complete occlusion identify patients less likely to recanalize completely.
Further study is required to determine whether these findings can guide management.
What This Means
This study looked at what happens to the blood vessel in the neck after a tear in its wall (cervical artery dissection), a cause of stroke in younger adults. Researchers reviewed records of 1,095 patients from 63 hospitals worldwide whose dissection had narrowed or blocked a single artery and who had follow-up vessel imaging at 6 months. About 58% of patients had a fully reopened vessel by 6 months.
The vessel was less likely to fully reopen in older patients, people with diabetes, current smokers, and those whose artery was completely blocked at the start. Complete blockage was also linked to taking longer to reopen. Whether patients were treated with antiplatelet drugs or anticoagulants made no apparent difference to reopening. Patients whose vessel did not fully reopen had a somewhat higher rate of later stroke (5.4% vs 3.5%), but this difference was not statistically significant.
This research suggests that some patients may be more likely than others to have a persistently narrowed or blocked artery, which could eventually help doctors decide how closely to monitor them with imaging. Because the study was retrospective, it cannot prove cause and effect, and the authors note that more research is needed before these findings are used to guide care.
Romoli M, Muppa J, Lee E, Mandel D, Kam W, Mac Grory B, et al.. (2026). Recanalization After Acute Cervical Artery Dissection: A Multicenter International Study.. Neurology. https://doi.org/10.1212/WNL.0000000000218566