Epidemiology of traumatic cervical artery dissections

Introduction: Unlike spontaneous cervical artery dissection (CeAD), the incidence of CeAD after a major trauma is not well characterized. This population-based observational study investigates the epidemiology and natural history of traumatic cervical artery dissection (CeADs) using data from the Rochester Epidemiology Project (REP) in Olmsted County, USA.

Methods: The REP system database has a high likelihood of complete case ascertainment and comparable demographics (age, sex) to the US population. After the initial screening of the database with ICD-based codes for carotid and vertebral dissections, meticulous review was performed to select patients with CeAD due to major trauma. We used Poisson regression to assess the association of age, sex, and time-period using crude incidence rates.

Results: Analyzing cases from 2002 to 2020, we identified 21 patients with traumatic CeAD, noting a significant 3.5-fold increase in incidence from 2002 to 2011-2012-2020 (0.37-1.29 per 100,000 person-years, p = 0.005). Only 23.8 % of cases experienced traumatic CeAD-related cerebral infarction. No patients received acute reperfusion therapies. Antithrombotic treatment predominantly involved single antiplatelet therapy (47.6 %) with aspirin. However, increasing use of dual antiplatelet therapy (11.8 %) along with declining use of anticoagulation (17.6 %) was also noted over time. We observed no recurrent strokes, dissections, or de-novo pseudoaneurysms. at the final follow-up.

Conclusion: The population-based incidence of traumatic CeAD is on the rise, potentially due to an increased screening in real-life practice leading to improved identification of cases that may have otherwise gone unrecognized. Our study also shows that traumatic CeADs tend to have a favorable prognosis.