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From the Departments of Neurology (Drs. Touzé and Mas) and Neuroradiology (Dr. Meder), Hôpital Sainte-Anne and Paris V University, Paris, Department of Neuroradiology (Dr. Gauvrit), Lille University Hospital, Department of Neurology (Dr. Moulin), Besançon University Hospital, and Department of Neuroradiology (Dr. Bracard), Nancy University Hospital, France.
Address correspondence and reprint requests to Dr. E. Touzé, Department of Neurology, Hôpital Sainte-Anne, 1 rue Cabanis, 75674 Paris Cedex 14, France; e-mail: touze{at}chsa.broca.inserm.fr
Objective: To assess the risk of stroke, TIA, or dissection recurrence after a first event of cervical artery dissection (CAD).
Methods: The authors undertook a historical cohort study of consecutive patients with a first event of CAD who were admitted in 24 departments of neurology within a period of at least 1 year. Patients were retrospectively selected from a stroke data bank or from the local administrative data bank using the 10th revision of the International Statistical Classification of Diseases. A neurologist and a radiologist reviewed all charts to validate diagnosis and collect data. In 2002, patients were interviewed by phone or during a visit by the local investigators.
Results: Four hundred fifty-nine patients (mean age 44.0 ± 9.7 years) were included in the study. Among the 457 survivors, 25 (5.5%) could not be contacted in 2002 because they had moved. After a mean follow-up of 31 months, four (0.9%) patients presented a recurrent ischemic stroke attributable to either not yet completely recovered initial CAD (n = 2) or a recurrent CAD (n = 2). Eight (1.8%) patients had a TIA without CAD recurrence. Two TIA occurred at the acute stage of CAD. Of the six remaining TIA, only one was associated with chronic arterial stenosis. In addition, two patients had recurrent CAD without stroke, giving a total of four (0.9%) CAD recurrences.
Conclusions: Patients with a first event of CAD have a very low risk of ischemic events or dissection recurrences. Ischemic events seem rarely to be in relation with chronic arterial lesions.
Received June 13, 2003. Accepted in final form July 29, 2003.
*See the Appendix on page 1350 for a list of Group members.
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