Supplementary Material for: Differential Risk Factors and Outcomes of Ischemic Stroke due to Cervical Artery Dissection in Young Adults

<b><i>Introduction:</i></b> Cervical artery dissection (CeAD) is a major cause of ischemic stroke in young adults. Our understanding of the specific risk factors and clinical course of CeAD is still evolving. In this study, we evaluated the differential risk factors and outcomes of CeAD-related strokes among young adults. <b><i>Methods:</i></b> The study population consisted of young patients 15–45 years of age consecutively admitted with acute ischemic stroke to our comprehensive stroke center between January 1, 2010, and November 30, 2016. Diagnosis of CeAD was based on clinical and radiological findings. Univariate and multivariable logistic regression analyses were used to assess the risk factors and clinical outcomes associated with CeAD-related strokes. <b><i>Results:</i></b> Of the total 333 patients with acute ischemic stroke included in the study (mean ± SD age: 36.4 ± 7.1 years; women 50.8%), CeAD was identified in 79 (23.7%) patients. As compared to stroke due to other etiologies, patients with CeAD were younger in age, more likely to have history of migraine and recent neck manipulation and were less likely to have hypertension, diabetes, and previous history of stroke. Clinical outcomes of CeAD were comparable to strokes due to other etiologies. Within the CeAD group, higher initial stroke severity and history of tobacco use were associated with higher modified Rankin Scale score at follow-up. <b><i>Conclusions:</i></b> While history of migraine and neck manipulation are significantly associated with CeAD, most of the traditional vascular risk factors for stroke are less prevalent in this group when compared to strokes due to other etiologies. For CeAD-related strokes, higher initial stroke severity and history of tobacco use may be associated with higher stroke-related disability, but overall, patients with CeAD have similar outcomes as compared to strokes due to other etiologies.

引言：颈动脉夹层（Cervical artery dissection，CeAD）是青年人群缺血性卒中的重要病因。目前学界对其特异性危险因素及临床病程的认知仍在不断演进。本研究针对青年群体中与颈动脉夹层相关的卒中，评估其差异性危险因素及预后情况。
方法：本研究的研究对象为2010年1月1日至2016年11月30日期间，于我院综合卒中中心连续收治的15~45岁急性缺血性卒中青年患者。颈动脉夹层的诊断依据为临床及影像学检查结果。采用单因素及多因素logistic回归分析，评估与颈动脉夹层相关卒中相关的危险因素及临床预后。
结果：本研究共纳入333例急性缺血性卒中患者（平均年龄±标准差：36.4±7.1岁；女性占比50.8%），其中79例（23.7%）确诊为颈动脉夹层相关卒中。与其他病因所致卒中患者相比，颈动脉夹层患者年龄更轻，偏头痛病史及近期颈部操作史的占比更高，而高血压、糖尿病及既往卒中病史的占比更低。颈动脉夹层相关卒中的临床预后与其他病因所致卒中相当。在颈动脉夹层患者亚组中，初始卒中严重程度更高及有吸烟史的患者，随访时的改良Rankin量表评分更高。
结论：尽管偏头痛病史与颈部操作史与颈动脉夹层存在显著相关性，但与其他病因所致卒中患者相比，颈动脉夹层患者群体中多数传统卒中血管危险因素的患病率更低。对于颈动脉夹层相关卒中而言，初始卒中严重程度更高及有吸烟史可能与更高的卒中相关致残率相关，但整体而言，颈动脉夹层患者的预后与其他病因所致卒中患者并无显著差异。