Differential outcomes and treatment in non-traumatic carotid versus vertebral cervical artery dissection: A national inpatient sample study

Elizabeth Lee; Liqi Shu; Setareh Salehi Omran; Eric D Goldstein; Nils Henninger; Thanh N Nguyen; James E Siegler; Lukas Strelecky; Farhan Khan; Christoph Stretz; Karen L Furie; Shadi Yaghi

doi:10.1016/j.jstrokecerebrovasdis.2024.108170

Differential outcomes and treatment in non-traumatic carotid versus vertebral cervical artery dissection: A national inpatient sample study

J Stroke Cerebrovasc Dis. 2024 Dec 6;34(2):108170. doi: 10.1016/j.jstrokecerebrovasdis.2024.108170. Online ahead of print.

Authors

Affiliations

¹ Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States. Electronic address: elizabeth_m_lee@brown.edu.
² Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States. Electronic address: liqi_shu@brown.edu.
³ Department of Neurology, University of Colorado, Aurora, CO, United States. Electronic address: SETAREH.SALEHIOMRAN@cuanschutz.edu.
⁴ Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States. Electronic address: EGoldstein@lifespan.org.
⁵ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, United States; Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States. Electronic address: Nils.Henninger@umassmed.edu.
⁶ Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States. Electronic address: thanh.nguyen@bmc.org.
⁷ Department of Neurology, University of Chicago, Chicago, IL, United States.
⁸ Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States. Electronic address: lukas_strelecky@brown.edu.
⁹ Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States. Electronic address: fkhan@lifespan.org.
¹⁰ Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States. Electronic address: christoph_stretz@brown.edu.
¹¹ Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States. Electronic address: kfurie@lifespan.org.
¹² Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States.

PMID: 39647554
DOI: 10.1016/j.jstrokecerebrovasdis.2024.108170

Abstract

Introduction: Cervical artery dissection (CAD) involves the carotid or vertebral artery. However, limited studies have compared their clinical features and outcomes.

Methods: We examined non-traumatic CAD patients from the National Inpatient Sample (2005-2019). Those diagnosed with both carotid and vertebral artery dissections were excluded. The evaluation included patient demographics, comorbidities, and treatment. Differences between carotid and vertebral dissections were assessed using survey-weighted stepwise backward logistic regression, followed by adjusted multivariable regressions for the primary outcomes of in-hospital mortality and routine discharge (to home or self-care).

Results: From 2005 to 2019, we included 123,224 non-traumatic CAD admissions without concurrent vertebral and carotid dissections. There were more carotid dissections than vertebral dissections (67,533 vs. 55,691). Compared to vertebral dissection, carotid dissection was associated with older age (54 [44-66] years vs. 49 [37-62] years, P<0.001), Black race (12.6% vs. 8.8%, P<0.001), White race (73.5% vs. 72.0%, P = 0.024), atrial fibrillation (10.8% vs. 6.3%, P<0.001), aortic dissection (7.7% vs. 0.3%, P<0.001), and fewer concurrent acute ischemic strokes (AIS) (47.8% vs. 56.7%, P<0.001).Within the concurrent AIS group, carotid CAD patients exhibited higher NIHSS (8 [2-17] vs. 2 [0-5], P<0.001), an increased utilization of intravenous thrombolysis (6.7% vs. 2.7% P<0.001), endovascular therapy (13.3% vs. 3.3%, P<0.001), and angioplasties (9.8% vs. 0.3%, P<0.001). Overall, carotid CAD was associated with more inpatient deaths (aOR 1.30, 95% CI 1.04-1.62, P=0.023) and less routine discharges (aOR 0.88, 95% CI 0.79-0.97, P=0.014) than vertebral CAD.

Conclusion: Our study underscores distinct comorbidity profiles and treatment patterns between non-traumatic carotid dissection and vertebral dissection groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.

Keywords: Carotid artery; Cervical dissection; Stroke; Vertebral artery.