Characteristics of patients with extracranial cervical artery dissections involving more than a single vessels: A subgroup analysis of STOP-CAD

INTRODUCTION: Cervical arterial dissections (CeAD) can involve either single (sCeAD) or multiple (mCeAD) arteries. Whether the involvement of a single versus multiple arteries is associated with outcomes remains unclear. We aimed to study associations between the number of affected arteries and clinical, imaging and outcome parameters. PATIENTS AND METHODS: Patients with CeAD from the STOP-CAD multicenter registry study were included. Clinical, imaging, treatment and outcome parameters were compared between patients with sCeAD and mCeAD. Regression analyses were performed to identify associations with multi-arteries involvement. RESULTS: Overall, 3858 STOP-CAD patients were included in this analysis and 443 (11.5%) had mCeAD. The presence of mCeAD was associated with age (adjusted odds ratio [aOR] 95% confidence intervals [95% CI] 0.99; (0.98-1.00)), female sex (aOR 1.5; 95% CI 1.17-1.91), recent upper respiratory infection (aOR 2.25; 95% CI 1.55-3.27), presence of connective tissue disease (aOR 3.11; 95% CI 2.32-4.17), severe arterial stenosis (aOR 1.95; 95% CI 1.95-2.58), intracranial extension (aOR 1.47; 95% CI 1.04-2.09), vertebral artery involvement (aOR 2.50; 95% CI 1.94-3.22) and presence of dissecting aneurysm (aOR 2.59; 95% CI 1.95-3.42). In adjusted analyses, mCeAD was not associated with clinical outcomes (ischemic stroke, mortality, and sICH; all p > 0.05). CONCLUSIONS: mCeAD does not appear to increase risk of subsequent stroke as compared to sCAD despite baseline risk factors suggestive of vasculopathy. mCeAD patients who did develop a stroke presented with milder strokes and less often had vessel occlusions compared to those with sCeAD. The presence of mCeAD did not impact outcomes.