E-248 Postpartum vertebral artery dissections: a report of 7 cases and literature review. (23rd July 2022)

• Record Type: Journal Article
• Authors: Lazarov, V; Monteiro, A; Almayman, F; Waqas, M; Cappuzzo, J; Levy, E; Siddiqui, A
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A214
• Page End: A215
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.359
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Vertebral artery dissections in the postpartum period have been associated with severe, life-threatening neurovascular events. Physiological changes during pregnancy such as progesterone mediated decrease in peripheral vascular resistance and increase in plasma volume have been proposed as potential mechanisms underlying postpartum vertebral artery dissections (ppVAD). Given the rare occurrence of ppVAD and paucity of existing cases, the etiology of this neurovascular phenomenon remains unclear. This study aims to clarify clinical characteristics, treatment course, and neurological outcomes of ppVAD. Methods: ICD-10 billing codes were used to identify patients who experienced ppVAD from 2001–2021. Results: 7 patients experienced ppVAD over a 20-year period. Patient characteristics included an average age of 30, BMI 29, 85.7% White non-hispanic, 14.3% Black or African American non-hispanic, and largely non-smoking (85.7% never, 14.3% former). Mode of delivery was available for four patients and did not influence likelihood for ppVAD (50% vaginal, 50% cesarean). On average, symptom onset occurred 70.6 days after delivery while hospital admission occurred at 73 days postpartum. Two cases occurred following cervical spine manipulation. The remainder started spontaneously at rest. Medical risk factors included history of migraines (28.6%), hypertension (14.3%), and multiple sclerosis (14.3%). The majority of cases were unilateral in distribution (71.4%). Approximately, 1.7 vertebral artery segments were involved on average where V3 was most commonly affected. 4 cases (57.1%) presented with comorbid PICA stroke. Initial treatment included heparin (57.1%), aspirin and clopidogrel (28.6%), and TPA (14.3%). Stent placement was required in 2 instances (28.5%). All patients were neurologically intact with either complete resolution or healing of ppVAD on magnetic resonance angiography (mRA) by 10 months following hospital admission. Two cases endured residual motor deficits (28.5%). Both of these patients experienced comorbid PICA stroke: one was managed conservatively with heparin bridge to warfarin and one received stent placemen upon initial presentation. [The above information is detailed in Table 1 ]. 2 subjects in previously reported cases required endovascular stent placement (6.1%) where 1 patient experienced residual unilateral hemiparesis (3.0%). Mortality resulting from ppVAD was not observed in this study or the literature. 5 patients in this study (71.4%) and 26 patients in the literature (78.8%) had complete resolution of symptoms following ppVAD. [The above information is detailed in Table 2 ] Conclusion: A limited cohort of 33 ppVADs exist in the literature. This study contributes 7 additional cases and suggests that, despite heterogenous management of ppVAD, the resulting outcomes were favorable. Disclosures: V. Lazarov: None. A. Monteiro: None. F. Almayman: None. M. Waqas: None. J. Cappuzzo: None. E. Levy: None. A. Siddiqui: None.