The Research On The Determinants Of Cervicocerebral Artery Dissection And The Predictors Of Ischemic Cerebrovascular Events Secondary To Cervicocerebral Artery Dissection

Background and ObjectivesCervicocerebral artery dissection(CAD)refers to an acute cerebrovascular disease,in which the intramural hematoma is formed if the rupture and bleeding of the vaso vasorum happens or the blood enters the vessel wall through the damaged and torn arterial intima.When the intramural hematoma is located between the intima and the media,it may lead to stenosis or even occlusion of the lumen of the involved artery.When the intramural hematoma is located between the media and the adventitia,a dissected aneurysm is formed easily.Since the first report of CAD in 1959,the research on this disease has been going on for 60 years.However,the etiology of CAD is not yet totally defined.Some relative factors that have been reported include hereditary connective tissue disease,hypertension,migraine,recent infection history,neck trauma and so on.The clinical manifestations of CAD include ischemic cerebrovascular event,subarachnoid hemorrhage,headache and neck pain,cranial nerve palsy et al.Epidemiological studies have found that although CAD is a rare cause of ischemic stroke,CAD is one of the major causes of ischemic stroke in young and middle-aged patients,accounting for 5% to 25% of patients with ischemic stroke below the age of 45 years old.And recurrent ischemic cerebrovascular events are significantly more frequent in patients with ischemic cerebrovascular events at onset than in patients with headache,pulsatile tinnitus or asymptomatic patients.Therefore,it is particularly important for CAD patients to timely assess the risk of secondary ischemic cerebrovascular events and actively improve risk factors and prevent the occurrence of ischemic cerebrovascular events.However,there are few reports on the similarities and differences in demographics and vascular risk factors between CAD patients with or without ischemic cerebrovascular events.Further research is needed in the follow-up study.In present study,we compare the clinical data of acute cerebral infarction patients caused by CAD with those other than CAD to explore the determinants of CAD.In addition,we compare the clinical data of CAD patients with and without ischemic cerebrovascular events to investigate the predictors of ischemic cerebrovascular events secondary to CAD.MethodsA total of 130 CAD patients without subarachnoid hemorrhage diagnosed and treated in the Department of Neurology and Neurological Intervention of the First Affiliated Hospital of Zhengzhou University were registered prospectively from 2010 to 2017.The clinical data of 81 CAD patients with acute cerebral infarction(CAD infarction group)and 84 consecutive non-CAD patients with acute cerebral infarction(non-CAD infarction group)registered prospectively in the Department of Neurology,were compared so as to explore the determinants of CAD.And 130 CAD patients were categorized into ischemic group(91 patients)and non-ischemic group(39 patients)according to whether CAD patients had ischemic cerebrovascular events or not.The predictors of ischemic cerebrovascular events secondary to CAD were investigated by comparison between two groups..Results 1.Baseline CharacteristicsThe mean age of 130 CAD patients was(50.9 ± 12.9)years and there were 95(73.5%)male patients and 35(26.5%)female patients.Among 130 CAD patients,91(70%)patients sustained ischemic cerebrovascular events including 81 patients with acute cerebral infarction and 10 patients with transient ischemic attack.The mean age of 84 non-CAD infarction patients was(55.5±8.1)years and there were 58(69.0%)male patients and 26(31.0%)female patients.2.The determinants of cervicocerebral artery dissectionThe mean age of CAD infarction group was(51.6±12.4)years,and(55.5±8.1)years in non-CAD infarction group,P=0.017;There were 35.8%(29/81)patients with the history of drinking in CAD infarction group and 50.0%(42/84)in non-CAD infarction group,P=0.066;The average level of triglycerides in CAD infarction group was(1.3±0.7)mmol/L,and(1.7±1.1)mmol/L in non-CAD infarction group,P=0.012;The average level of total cholesterol in CAD infarction group was(3.9±1.1)mmol/L and(4.2±1.2)mmol/L in non-CAD infarction group,P=0.096;There were 42.0%(34/81)of headache and neck pain in CAD infarction group and 22.6%(19/84)in non-CAD infarction group,P=0.008.Multivariate logistic regression analysis showed that age(OR 0.96,95%CI 0.93-0.99,P=0.025)and the level of triglycerides(OR 0.54,95%CI 0.34-0.85,P=0.008)were negatively correlated with CAD,and headache and neck pain(OR 2.71,95%CI 1.32-5.55,P=0.007)shown a positive correlation with CAD.3.The predictors of ischemic cerebrovascular events secondary to cervicocerebral artery dissectionIn the ischemic group 46.2%(42/91)of the artery dissections were located in the anterior circulation,and 25.6%(10/39)in the non-ischemic group were located in the anterior circulation,P=0.029;The average level of high density lipoprotein in the ischemic group was(1.1±0.4)mmol/L,and(1.3±0.5)mmol/L in the non-ischemic group,P=0.083.Multivariate logistic regression analysis showed that there was a positive correlation between anterior circulation and ischemic cerebrovascular events(OR=3.20,95% CI 1.31-7.86,P=0.011),but the level of high density lipoprotein was negatively correlated with ischemic cerebrovascular events(OR=0.34,95% CI 0.13-0.87,P=0.024)secondary to CAD.Conclusions1.CAD without SAH is more common in male patients presenting wih ischemic cerebrovascular events frequently.2.The young and middle-aged cerebral infarction patients with heahache and neck pain and low level of triglycerides are highly suggestive of CAD.3.We should attach great importance to CAD patients with an artery dissection located in the anterior circulation and low level of high density lipoprotein,and prompt treatment should be taken to prevent the occurrence of ischemic cerebrovascular events.