Cervical artery dissection in patients ≥60 years: Often painless, few mechanical triggers.

Traenka, Christopher; Dougoud, Daphne; Simonetti, Barbara Goeggel; Metso, Tiina M; Debette, Stéphanie; Pezzini, Alessandro; Kloss, Manja; Grond-Ginsbach, Caspar; Majersik, Jennifer J; Worrall, Bradford B; Leys, Didier; Baumgartner, Ralf; Caso, Valeria; Béjot, Yannick; Compter, Annette; Reiner, Peggy; Thijs, Vincent; Southerland, Andrew M; Bersano, Anna; Brandt, Tobias; Gensicke, Henrik; Touzé, Emmanuel; Martin, Juan J; Chabriat, Hugues; Tatlisumak, Turgut; Lyrer, Philippe; Arnold, Marcel; Engelter, Stefan T

OBJECTIVE In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years. METHODS We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients-Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated. RESULTS Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 3.08 [2.25-4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0-2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]). CONCLUSION In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.