Wahood Waseem, Bucak Bilal, Oakley Carlee I, Keser Zafer
Department of Interventional Radiology, School of Medicine, Jackson Memorial Hospital/University of Miami Miller, Miami, FL.
Division of Cerebrovascular Disorders and Stroke, Mayo Clinic, Department of Neurology, Rochester, MN.
Neurologist. 2025 Jul 1;30(4):191-195. doi: 10.1097/NRL.0000000000000596.
Cervical artery dissection (CeAD) was previously thought to be more common in men, but recent epidemiology studies show a disproportionate increase in the incidence of CeAD in women. In addition to sex-based differences in clinical presentation, there are unique biological risk factors for CeAD in women. Identifying risk factors for ischemic stroke in CeAD is crucial in individualizing treatment options. Herein, we utilized an inpatient cohort to investigate whether noncancerous gynecologic conditions or pregnancy are risk factors for ischemic stroke in CeAD.
The National Inpatient Sample was queried from 2016 to 2020 for patients diagnosed with CeAD using the International Classification of Diseases, 10th edition, correction of the mean codes. Diagnoses of pregnancy/puerperium and noncancerous gynecologic conditions were identified. Among CeAD admissions, acute ischemic stroke (AIS) was also identified. Hierarchical, multivariable regression, adjusted for patient demographics and medical comorbidities, was conducted to assess factors associated with AIS.
A total of 34,925 women with CeAD were identified. Of these women, 2.1% were pregnant or up to six weeks postpartum, 1.3% had a noncancerous gynecologic condition, and 0.09% had both active pregnancy/puerperium and a noncancerous gynecologic condition. Noncancerous gynecologic conditions (odds ratio = 1.86, P = 0.012) were found to be an independent risk factor for AIS in CeAD but not active pregnancy/puerperium (odds ratio = 0.84, P = 0.34).
In this national inpatient sample of female patients with CeAD, the presence of noncancerous gynecologic conditions is associated with an increased risk of AIS. Further studies are needed to validate this observation and help guide the best antithrombotic treatment decisions in this patient population.
颈内动脉夹层（CeAD）以前被认为在男性中更为常见，但最近的流行病学研究表明，CeAD在女性中的发病率呈不成比例的上升。除了临床表现存在基于性别的差异外，女性CeAD还有独特的生物学危险因素。确定CeAD中缺血性卒中的危险因素对于个体化治疗方案至关重要。在此，我们利用一个住院患者队列来研究非癌性妇科疾病或妊娠是否为CeAD中缺血性卒中的危险因素。
使用国际疾病分类第十版修正后的平均编码，查询2016年至2020年全国住院患者样本中诊断为CeAD的患者。确定妊娠/产褥期和非癌性妇科疾病的诊断。在CeAD入院患者中，还确定了急性缺血性卒中（AIS）。进行分层多变量回归分析，并对患者人口统计学和医疗合并症进行校正，以评估与AIS相关的因素。
共确定34925例患有CeAD的女性。在这些女性中，2.1%处于妊娠或产后六周内，1.3%患有非癌性妇科疾病，0.09%同时处于妊娠/产褥期且患有非癌性妇科疾病。发现非癌性妇科疾病（比值比=1.86，P=0.012）是CeAD中AIS的独立危险因素，但妊娠/产褥期不是（比值比=0.84，P=0.34）。
在这个全国住院女性CeAD患者样本中，非癌性妇科疾病的存在与AIS风险增加相关。需要进一步研究来验证这一观察结果，并帮助指导该患者群体的最佳抗栓治疗决策。
