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From the Department of Neurology (D.G., H.C.v.B., P.V., H.S., R.W.B.), University Hospital Zürich; Department of Neurology (M.A., H.P.M.), University Hospital Bern; Department of Biostatistics (V.R.), University of Lausanne, Switzerland; and Assistance Publique (M.G.B.), Hopitaux de Paris, Department of Neurology, University Hospital, Laboisiere, Paris, France.
Address correspondence and reprint requests to Dr. Dimitrios Georgiadis, Department of Neurology, Frauenklinikstrasse 26, CH-8091 Zürich, Switzerland dimitrios.georgiadis{at}usz.ch
Background: No randomized study has yet compared efficacy and safety of aspirin and anticoagulants in patients with spontaneous dissection of the cervical carotid artery (sICAD).
Methods: Prospectively collected data from 298 consecutive patients with sICAD (56% men; mean age 46 ± 10 years) treated with anticoagulants alone (n = 202) or aspirin alone (n = 96) were retrospectively analyzed. Admission diagnosis was ischemic stroke in 165, TIA in 37, retinal ischemia in 8, and local symptoms and signs (headache, neck pain, Horner syndrome, cranial nerve palsy) in 80 patients, while 8 patients were asymptomatic. Clinical follow-up was obtained after 3 months by neurologic examination (97% of patients) or structured telephone interview. Outcome measures were 1) new cerebral ischemic events, defined as ischemic stroke, TIA, or retinal ischemia, 2) symptomatic intracranial hemorrhage, and 3) major extracranial bleeding.
Results: During follow-up, ischemic events were rare (ischemic stroke, 0.3%; TIA, 3.4%; retinal ischemia, 1%); their frequency did not significantly differ between patients treated with anticoagulants (5.9%) and those treated with aspirin (2.1%). The same was true for hemorrhagic adverse events (anticoagulants, 2%; aspirin, 1%). New ischemic events were significantly more frequent in patients with ischemic events at onset (6.2%) than in patients with local symptoms or asymptomatic patients (1.1%).
Conclusions: Within the limitations of a nonrandomized study, our data suggest that frequency of new cerebral and retinal ischemic events in patients with spontaneous dissection of the cervical carotid artery is low and probably independent of the type of antithrombotic treatment (aspirin or anticoagulants).
Abbreviations: CI = confidence interval; DSA = digital subtraction angiography; ICH = intracranial hemorrhage; IST = International Stroke Trial; MCA = middle cerebral artery; MRA = magnetic resonance angiography; NIHSS = National Institutes of Health Stroke Scale; OR = odds ratio; PSV = peak systolic velocity; RI = resistance index; sICAD = spontaneous dissection of the cervical carotid artery; sVAD = spontaneous vertebral artery dissection.
e-Pub ahead of print on March 25, 2009, at www.neurology.org.
Disclosure: The authors report no disclosures.
Received July 1, 2008. Accepted in final form February 2, 2009.
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