Abstract 002: Efficacy and Safety of Acute Therapy in Cervical Artery Dissection‐Related Ischemic Stroke

Introduction Cervical artery dissection (CeAD) is a significant cause of ischemic stroke in young adults, accounting for 25% of such cases. However, the optimal management strategies, including the use of intravenous thrombolysis (IVT) and endovascular treatment (EVT) with emergent carotid stenting, remain unclear. Current evidence does not adequately define the efficacy and safety of these interventions, particularly their impact on functional outcomes and the risk of symptomatic intracranial hemorrhage (ICH). Method We performed a secondary analysis using data from the retrospective STOP‐CAD study to assess the effectiveness and safety of IVT in patients with spontaneous CeAD presenting with acute ischemic stroke, as well as the outcomes of emergent carotid stenting during EVT in patients with tandem occlusion due to CeAD. Primary outcomes included 90‐day functional independence (modified Rankin Scale 0‐2) and the incidence of symptomatic ICH. Secondary outcomes for EVT included the rate of successful intracranial recanalization and stent‐related complications. Result Among 1,653 patients with spontaneous CeAD, 31.0% received IVT. IVT was associated with significantly higher odds of achieving 90‐day functional independence (adjusted odds ratio [aOR] = 1.67, 95% confidence interval [CI]: 1.23‐2.28, p = 0.001) without a corresponding increase in symptomatic ICH (aOR = 1.52, 95% CI: 0.79‐2.92, p = 0.215). In the EVT cohort of 328 patients with tandem occlusion, 45.7% underwent emergent carotid stenting. Stenting was linked to a higher rate of successful intracranial recanalization (aOR = 2.62, 95% CI: 1.52‐4.50, p < 0.001) but did not significantly affect 90‐day functional independence (aOR = 1.23, 95% CI: 0.82‐1.86, p = 0.32) or symptomatic ICH (aOR = 0.95, 95% CI: 0.41‐2.20, p = 0.91). Stent‐related complications included stent thrombosis in 14.0% of patients, symptomatic ICH in 6.7%, distal embolization in 5.3%, worsening dissection in 3.3%, access site complications in 2.7%, and stent migration in 0.7%. Conclusion Our findings indicate that IVT is beneficial in improving functional outcomes for patients with CeAD‐related ischemic stroke without increasing the risk of symptomatic ICH, supporting its recommended use in current clinical guidelines. Conversely, while emergent carotid stenting during EVT enhances recanalization success, it does not translate into improved functional outcomes or safety. These results underscore the necessity for randomized controlled trials to further investigate and refine the role of IVT and stenting in the management of CeAD‐related strokes, optimizing treatment strategies for this challenging condition.