STOP-CAD study [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== STOP-CAD study ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1HaIafHQm-66xXCxPHTl0PQfZN8vtplVtVdhFOPVOoDdyn8Q7Q/?limit=15&utm_campaign=pubmed-2&fc=20250130135055}}


The STOP-CAD (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection) study is a multicenter, international, [[retrospective]] [[observational]] study that investigated the effectiveness of [[antithrombotic]] [[treatment]]s in preventing strokes among patients with cervical artery dissection (CeAD). Conducted across 63 sites in 16 countries, the study included 3,636 patients diagnosed with CeAD. 

The primary objective was to compare the outcomes of patients treated with anticoagulants versus those treated with antiplatelet therapy. The findings revealed that by day 180, 4.4% of patients experienced a subsequent ischemic stroke, with 87% of these strokes occurring within the first 30 days. While anticoagulation was associated with a non-significantly lower risk of subsequent ischemic stroke compared to antiplatelet therapy, it was linked to a higher risk of major hemorrhage by day 180. Notably, patients with occlusive dissection appeared to benefit more from anticoagulation in terms of reducing ischemic stroke risk.

Based on these results, the study suggests that if anticoagulation is chosen as the initial treatment, it may be prudent to switch to antiplatelet therapy after 30 days to mitigate the risk of major bleeding, especially since the majority of subsequent ischemic strokes occur within the first 30 days. However, the study emphasizes the need for large prospective studies to validate these findings. ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/38335240/?utm_source=chatgpt.com))

In summary, the STOP-CAD study provides valuable insights into the management of cervical artery dissection, highlighting the potential benefits and risks associated with anticoagulation and antiplatelet therapies. 

===== Retrospective observational cohort studies =====
Sousa et al. investigated the impact of emergent [[carotid artery stenting]] during [[endovascular treatment for acute ischemic stroke]] in patients with [[tandem occlusion]] secondary to [[cervical carotid artery dissection]].
This was a secondary analysis of patients treated with EVT for AIS due to occlusive [[carotid artery dissection]] and [[tandem occlusion]] included in the retrospective international Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection [[STOP-CAD Study]]. 
They compared patients with and without emergent [[stenting]]. The primary [[efficacy]] and [[safety]] outcomes were 90-day functional [[independence]] (modified Rankin Scale 0-2) and symptomatic [[intracranial hemorrhage]] (sICH) within 24h after EVT. The procedural outcome was successful intracranial [[recanalization]] (mTICI 2b/3). 
They used mixed-effect [[logistic regression]] adjusting for site, age, and [[NIHSS]]. In additional analyses, they used inverse probability of treatment weighting and adjusted for [[ASPECTS]]. 
Of the 4023 patients enrolled in STOP-CAD, 328 presented with [[anterior circulation]] AIS due to tandem occlusion and underwent EVT. The median age was 51 years (interquartile range 44-58), and 96 patients (29.3%) were female. One hundred fifty patients (45.7%) underwent emergent [[stenting]]. There was no significant association between stenting and 90-day functional independence (62.0% vs 59.7%; aOR 1.23, 95% CI 0.82-1.86, p=0.315) or sICH (7.3% vs 7.9%; aOR OR 0.95, 95% CI 0.41-2.2, p=0.913). Emergent [[carotid artery stenting]] was associated with successful intracranial recanalization (81.8% vs 76.6% aOR 2.62, 95% CI 1.52-4.5, p<0.001). Results did not meaningfully change in additional analyses. 
In patients presenting with an acute anterior circulation tandem occlusion secondary to [[cervical carotid artery dissection]], emergent stenting was associated with a higher likelihood of successful intracranial recanalization but not improved functional outcomes or increased sICH. It remains unclear whether emergent stenting led to successful intracranial recanalization or whether patients with successful intracranial recanalization were more likely to be stented. Randomized trials are warranted
((Sousa JA, Rodrigo-Gisbert M, Shu L, Luo A, Xiao H, Mahmoud NA, Shah A, Oliveira Santos AL, Moore M, Mandel DM, Heldner MR, Barata V, Bernardo-Castro S, Henninger N, Muppa J, Arnold M, Nehme A, Rothstein A, Khazaal O, Kaufmann JE, Engelter ST, Traenka C, Metanis I, Leker RR, Nolte CH, Ghannam M, Samaniego EA, AlMajali M, Poppe AY, Romoli M, Frontera JA, Zedde M, Kam W, Mac Grory B, Saleh Velez FG, Ranasinghe T, Siegler JE, Zubair AS, Marto JP, Klein P, Nguyen TN, Abdalkader M, Mantovani GP, Simpkins AN, Sen S, Elnazeir M, Yaghi S, Sargento-Freitas J, Requena M. Emergent Carotid Stenting During Thrombectomy in Tandem Occlusions Secondary to Dissection: A STOP-CAD Secondary Study. Stroke. 2025 Jan 30. doi: 10.1161/STROKEAHA.124.048295. Epub ahead of print. PMID: 39882629.))
----
Sousa et al. provide valuable insights into the role of emergent CAS in AIS patients with tandem occlusion due to cervical carotid artery dissection. While emergent stenting was associated with improved procedural success, it did not significantly enhance functional recovery or increase the risk of sICH. The study underscores the need for randomized controlled trials to establish definitive guidelines regarding emergent CAS in this patient population. Future research should focus on identifying subgroups that may derive greater benefits from stenting and assessing long-term outcomes beyond the 90 days.