Mayer-Suess Lukas, Knoflach Michael, Peball Tamara, Mangesius Stephanie, Steiger Ruth, Pereverzyev Sergiy, Lerchner Hannes, Blache Ludovic, Mayr Manuel, Ratzinger Gudrun, Kiechl Stefan, Gizewski Elke R, Pechlaner Raimund
Department of Neurology (L.M.-S., M.K., T.P., S.K., R.P.), Medical University of Innsbruck, Austria.
VASCage, Research Centre on Clinical Stroke Research, Innsbruck, Austria (M.K., S.K.).
Stroke. 2025 Feb;56(2):413-419. doi: 10.1161/STROKEAHA.124.049046. Epub 2024 Dec 19.
The pathogenesis of spontaneous cervical artery dissection remains unclear, and no established predictors of recurrence exist. Our goal was to investigate the potential association between cervical artery tortuosity, a characteristic of patients with connective tissue disorder, and spontaneous cervical artery dissection.
The ReSect study (Risk Factors for Recurrent Cervical Artery Dissection) is an observational study that invited all spontaneous cervical artery dissection patients treated at the Innsbruck University Hospital between 1996 and 2018 for clinical and radiological follow-up. Internal carotid and vertebral artery tortuosity was assessed on magnetic resonance angiography using a validated 3-dimensional algorithm. Differences between patients and healthy controls as well as dependent on recurrence status were assessed by applying χ, Mann-Whitney test, and Kruskal-Wallis test where applicable, and confounders were established by bivariable Pearson correlation. Logistic regression was used to address the impact of tortuosity on dissection occurrence and recurrence as well as its association to extracellular matrix proteome data derived from skin biopsies in a subset of patients.
Magnetic resonance angiography was performed a median of 6.5 years after dissection in the included dissection patients. Patients with dissection (n=125) had significantly increased values of internal carotid artery tortuosity compared with healthy controls (n=24; odds ratio, 2.65 [95% CI, 1.68-3.86], 1 SD increase; <0.01). This was also true for patients with long-term dissection recurrence (n=7) when compared with those with single time-point dissection (n=118; odds ratio, 2.00 [95% CI, 1.47-3.99], 1 SD increase; <0.01). In patients with dissection and available extracellular matrix protein data (n=37), 6 of 13 (46.2%) proteins previously found linked with dissection recurrence were also associated with increased tortuosity. All 3 proteins associated with both anterior and posterior circulation tortuosity belonged to the desmosome-related cluster.
Internal carotid artery tortuosity is elevated in spontaneous cervical artery dissection patients compared with healthy controls, and this difference is most pronounced if individuals suffer from long-term dissection recurrence. Additionally, an association between tortuosity, being a readily measurable biomarker in routine magnetic resonance angiography, and proteomic markers of dissection recurrence exists, further enhancing the prospect of underlying subclinical connective tissue disease in dissection patients.
自发性颈内动脉夹层的发病机制尚不清楚，目前也没有公认的复发预测指标。我们的目标是研究颈内动脉迂曲（一种结缔组织疾病患者的特征）与自发性颈内动脉夹层之间的潜在关联。
ReSect研究（复发性颈内动脉夹层的危险因素）是一项观察性研究，邀请了1996年至2018年期间在因斯布鲁克大学医院接受治疗的所有自发性颈内动脉夹层患者进行临床和影像学随访。使用经过验证的三维算法在磁共振血管造影上评估颈内动脉和椎动脉的迂曲情况。适用时，通过χ检验、曼-惠特尼检验和克鲁斯卡尔-沃利斯检验评估患者与健康对照之间以及取决于复发状态的差异，并通过双变量皮尔逊相关性确定混杂因素。在一部分患者中，使用逻辑回归来分析迂曲对夹层发生和复发的影响及其与皮肤活检获得的细胞外基质蛋白质组数据的关联。
纳入研究的夹层患者在夹层发生后中位6.5年进行了磁共振血管造影。与健康对照（n = 24）相比，夹层患者（n = 125）的颈内动脉迂曲值显著增加（优势比，2.65 [95% CI，1.68 - 3.86]，1标准差增加；<0.01）。与单次夹层患者（n = 118）相比，长期夹层复发患者（n = 7）也是如此（优势比，2.00 [95% CI，1.47 - 3.99]，1标准差增加；<0.01）。在有可用细胞外基质蛋白数据的夹层患者（n = 37）中，先前发现与夹层复发相关的13种蛋白中有6种（46.2%）也与迂曲增加有关。与前后循环迂曲均相关的所有3种蛋白都属于桥粒相关簇。
与健康对照相比，自发性颈内动脉夹层患者的颈内动脉迂曲增加，如果个体患有长期夹层复发，则这种差异最为明显。此外，在常规磁共振血管造影中易于测量的生物标志物迂曲与夹层复发的蛋白质组学标志物之间存在关联，这进一步增强了夹层患者潜在亚临床结缔组织疾病的可能性。
