Aortic Root Dilatation in Patients With Spontaneous Cervical Artery Dissection

BACKGROUND: Spontaneous cervical artery dissections are a relatively common cause of ischemic stroke in young adults. Their mechanism is unknown, though it is generally assumed that an underlying minor form of extracellular matrix defect could exist. The present study tested the hypothesis that aortic and cardiac morphological abnormalities usually seen in patients with heritable connective diseases are more frequent in patients with spontaneous cervical artery dissections than in patients without such dissections. METHODS AND RESULTS: We performed a case-control study of 28 case patients with spontaneous cervical artery dissection and 84 control subjects with an ischemic stroke not due to cervical artery dissection. Control subjects were matched to case patients for age (+/-5 years), sex, and year of hospitalization. The aortic root was more frequently enlarged (ie, diameter > 34 mm) in case patients (56%) than in control subjects (15%). Mitral valve prolapse, mitral valve dystrophy, and aortic valve dystrophy were more frequent in case patients than in control subjects. In multivariate analyses, aortic diameter > 34 mm was the only variable associated with an increased risk of spontaneous cervical artery dissection (odds ratio, 14.2; 95% CI, 3.2 to 63.6; P < .001). CONCLUSIONS: These results suggest that aortic root diameter enlargement is associated with an increased risk of spontaneous cervical artery dissection. This finding is consistent with the idea that a generalized defect of the extracellular matrix is present in patients with spontaneous cervical artery dissection.