After craniocervical dissection, one in five had a recurrent stroke within a year, mostly in the first week

Design

Retrospective analysis of a prospective national stroke registry

Population

711 patients with ischaemic stroke or TIA from craniocervical artery dissection, diagnosed within 7 days (South Korea)

Primary outcome

Recurrent ischaemic stroke at 1 year

Effect

8.7% day 1, 17.4% week 1, 19.9% year 1; double lumen aHR 1.87 (1.15–3.04)

This analysis used the Korean nationwide CRCS-K-NIH registry (2011 to 2021). Of 75,903 patients admitted with ischaemic stroke or TIA, 711 (0.94%) had craniocervical artery dissection diagnosed within seven days of onset; median arrival was 7.7 hours after onset. Mean age was 49 and 76% of dissections were intracranial, reflecting an East Asian population.

Recurrent ischaemic stroke, MRI-confirmed, was 8.7% on day 1, 17.4% within a week and 19.9% at one year. The incidence rate fell from 271 per 1,000 person-days on day 1 to 0.1 after day 7. Location did not predict recurrence. Stenosis without dilatation (aHR 1.69, 95% CI 1.04 to 2.75) and a double lumen (aHR 1.87, 1.15 to 3.04) did; a double lumen carried particular risk on days 2 to 3 (IRR 3.84).

Earlier studies, enrolling later, underestimated early risk. The practical message is that the hyperacute period is when monitoring and antithrombotic decisions matter most. Intracranial dissection is far more common in Asian populations than in Western series, which is relevant to Indian practice.

• Most recurrent strokes after dissection happen in the first 7 days; admit and monitor closely in that window.
• Start antithrombotic therapy early unless contraindicated, following local stroke protocol; in intracranial dissection, first exclude subarachnoid haemorrhage or a dissecting aneurysm.
• Look for a double lumen or stenosis without dilatation on vessel imaging; both marked higher recurrence risk.
• Intracranial dissection is common in Asian patients; image intracranial vessels, not only the neck.
• Recurrence after the first week was rare in this cohort.

Why it matters

It moves the risk window for dissection-related stroke into the first days, when many patients are still being assessed.

Don't overread it

The cohort was Korean and mostly intracranial dissections; the pattern may differ in populations with more extracranial dissection.

The statistics, in plain English

The adjusted hazard ratios for double lumen (1.87) and stenosis (1.69) have lower confidence limits just above 1.0, so the associations are unlikely to be chance but are imprecise. Because this is a registry, treatment was not randomised, so differences in treatment could account for some of the associations.

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