‘Arterial dissection,’ a cause of ischemic stroke in young people: 1 in 5 patients have another ischemic stroke... The first week is critical [Health Check]

[Financial News] Patients aged 50 or younger with ischemic stroke should be evaluated for cervicocephalic arterial dissection, in which the walls of blood vessels in the neck and head tear. One in five patients who had an ischemic stroke due to this condition suffered another stroke within a year, and most recurrences occurred during the first week.

Cervicocephalic arterial dissection occurs when the inner wall of an artery in the head or neck that supplies blood to the brain tears, allowing blood to seep between the layers of the vessel wall. As blood collects between the layers and thickens the wall, the vessel can narrow or become blocked, reducing blood flow to the brain and potentially causing an ischemic stroke. It is considered a major cause of ischemic stroke in people aged 50 or younger.
A research team led by Professor Bae Hee-jun of the Department of Neurology at Seoul National University Bundang Hospital, along with Professor Hong Jeong-ho of Keimyung University Dongsan Hospital and Professor Jang Seong-hwa of International St. Mary’s Hospital, analyzed data from the multicenter stroke cohort CRCS-K-NIH, which includes 17 university hospitals in South Korea, and reported these findings. The results were published in the international neurology journal Neurology on the 13th.
Recurrent ischemic strokes caused by this condition are known to occur most often soon after symptoms begin. However, most previous studies examined patients about a week after symptom onset, making it difficult to capture the high-risk early period. Another limitation was that they did not clearly distinguish temporary changes in symptoms from actual recurrences.
The research team followed for one year 711 patients diagnosed with cervicocephalic arterial dissection within seven days of symptom onset, among 75,903 patients hospitalized with acute ischemic stroke or transient ischemic attack (TIA, or mini-stroke) from 2011 to 2021. These patients arrived at the hospital a median of 7.7 hours after symptom onset, allowing them to be observed earlier than in previous studies. During hospitalization, a recurrence was recorded only when an MRI confirmed a new ischemic stroke or an enlargement of an existing lesion.
The cumulative recurrence rate rose rapidly, reaching 8.7% on the first day and 17.4% within one week. It increased only slightly thereafter, reaching 18.4% within one month and 19.9% within one year. Expressed as the number of recurrences per 1,000 patients observed for one day, the rate fell sharply from 271.2 on the first day to 44.9 on days 2–3 and 13.8 on days 4–7, and was just 0.1 after the first week.

Clinicians have traditionally focused on whether the dissection occurred in a blood vessel inside the head or in a neck vessel. In this study, however, the location of the dissection was not significantly associated with recurrence risk.
The shape of the blood vessel was clearly associated with recurrence risk. Blood that seeps between the layers of the vessel wall can push inward, narrowing the vessel, or push outward, causing it to expand. On vascular imaging, patients whose vessels showed narrowing alone had a 1.69-fold higher risk of recurrence within a year than those whose vessels had both narrowed and expanded sections.
Patients whose blood vessels appeared to have two channels for blood flow had a 1.87-fold higher risk of recurrence within a year than those without this feature, and the recurrence rate on days 2–3 after symptom onset was 3.84 times as high. The researchers explained that when a new space through which blood flows forms between the layers of a vessel wall, it can lie alongside the original channel and look like two separate pathways.
Professor Hong Jeong-ho said, “When assessing recurrence risk, it is important to pay attention to the morphological features seen on vascular imaging,” adding, “This will provide an important basis for stratifying risk according to the shape of the dissected vessel and developing tailored treatment strategies.”
Professor Bae Hee-jun stressed, “The significance of this study is that it examined early recurrence patterns that previous studies could easily have missed, using nationwide data in which patients were prospectively enrolled from the time of hospitalization,” adding, “Since recurrences are concentrated in the first week, close monitoring during this period is essential even when a patient’s condition appears stable.”
The study was conducted with support from the Korea Disease Control and Prevention Agency’s National Institute of Health, the Ministry of Health and Welfare, and the Korea Health Industry Development Institute.



[email protected] Jeong Myeong-jin, Medical Correspondent Reporter