Recurrent versus first cervical artery dissection - A retrospective study of clinical and vascular characteristics.

OBJECTIVE Most recurrent cervical artery dissection (CeAD) events occur shortly after the acute first CeAD. This study compared characteristics of recurrent and first CeAD events and searched for associations between subsequent events of an individual person. METHODS CeAD patients with a new CeAD event occuring during a three to six months follow-up were retrospectively selected in seven specialized stroke centers. Clinical and vascular characteristics of the initial and the recurrent CeADs were compared. RESULTS The study sample included 76 patients. Recurrent CeADs were occlusive in one (1.3%) patient, caused cerebral ischemia in 13 (17.1%) and were asymptomatic in 39 (51.3%) patients, compared to 29 (38.2%) occlusive, 42 (55.3%) ischemic and no asymptomatic first CeAD events. In 52 (68.4%) patients, recurrent dissections affected both internal carotid arteries or both vertebral arteries, while 24 (31.6%) patients had subsequent dissections in both types of artery. Twelve (28.6%) of 42 patients with an ischemic first dissection had ischemic symptoms due to the recurrent CeADs, too. However, only one (1.3%) of 34 patients with a non-ischemic first CeAD suffered ischemia upon recurrence. CONCLUSION Recurrent CeAD typically affects the same site of artery. It causes ischemic events less often than first CeAD. The risk that patients, who presented with solely non-ischemic symptoms of a first CeAD, will have ischemic symptoms in case of a recurrent CeAD seems very small.