Male Sex Is Associated With Cervical Artery Dissection in Patients With Fibromuscular Dysplasia

Charlotte Arnaud, Marion Boulanger, Aurélien Lorthioir, Laurence Amar, Arshid Azarine, Louis Boyer, Gilles Chatellier, Silvia Di Monaco, Xavier Jeunemaitre, Adrian Kastler, Elie Mousseaux, Catherine Oppenheim, Frédéric Thony, Alexandre Persu, Jeffrey W Olin, Michel Azizi, Emmanuel Touzé, ARCADIA Co‐investigators †, Arshid Azarine, Michel Azizi, Gilles Chatellier, Antoine Chedid, Béatrice Fiquet, Xavier Jeunemaitre, Elie Mousseaux, Pierre-François Plouin, Jean-Philippe Baguet, Olivier Ormezzano, Frédéric Thony, François Silhol, Eric Bodiguel, Valérie Domigo, Catherine Oppenheim, Marta Pasquini, Emmanuel Touzé, Denis Trystram, Louis Boyer, Pierre Clavelou, Bernard Chamontin, Béatrice Duly-Bouhanick, Hilde Hénon, Claire Mounier-Vehier, Parla Astarci, Pierre Goffette, Frank Hammer, Jean-Philippe Lengelé, Alexandre Persu, Francesca Severino, Robert Verhelst, Claire Le Hello, Philippe Gosse, Dominique Hervé, Fernando Pico, Michèle Kessler, Patrick Rossignol, Yves Sanson, Mathieu Zuber, Mikael Mazighi, Sonia Alamowitch, Charlotte Arnaud, Marion Boulanger, Aurélien Lorthioir, Laurence Amar, Arshid Azarine, Louis Boyer, Gilles Chatellier, Silvia Di Monaco, Xavier Jeunemaitre, Adrian Kastler, Elie Mousseaux, Catherine Oppenheim, Frédéric Thony, Alexandre Persu, Jeffrey W Olin, Michel Azizi, Emmanuel Touzé, ARCADIA Co‐investigators †, Arshid Azarine, Michel Azizi, Gilles Chatellier, Antoine Chedid, Béatrice Fiquet, Xavier Jeunemaitre, Elie Mousseaux, Pierre-François Plouin, Jean-Philippe Baguet, Olivier Ormezzano, Frédéric Thony, François Silhol, Eric Bodiguel, Valérie Domigo, Catherine Oppenheim, Marta Pasquini, Emmanuel Touzé, Denis Trystram, Louis Boyer, Pierre Clavelou, Bernard Chamontin, Béatrice Duly-Bouhanick, Hilde Hénon, Claire Mounier-Vehier, Parla Astarci, Pierre Goffette, Frank Hammer, Jean-Philippe Lengelé, Alexandre Persu, Francesca Severino, Robert Verhelst, Claire Le Hello, Philippe Gosse, Dominique Hervé, Fernando Pico, Michèle Kessler, Patrick Rossignol, Yves Sanson, Mathieu Zuber, Mikael Mazighi, Sonia Alamowitch

Abstract

Background Cervical artery dissection (CeAD) is a frequent manifestation of fibromuscular dysplasia (FMD). However, risk factors for CeAD are unknown. We investigated factors associated with CeAD in the ARCADIA (Assessment of Renal and Cervical Artery Dysplasia) registry. Methods and Results The ARCADIA registry includes women or men aged ≥18 years, with a diagnosis of renal, cervical, or intracranial artery FMD, who were prospectively recruited at 16 university hospitals in France and Belgium. Diagnosis of acute or past CeAD at inclusion was established on imaging according to standard diagnostic criteria. Associations between potential determinants and CeAD were assessed by logistic regression analyses. Among 469 patients (75 men) with FMD, 65 (13.9%) had CeAD. Patients with CeAD were younger, more likely to be men, have a history of migraine, and less likely to have a history of hypertension than patients without CeAD. In the multivariable analysis, male sex (odds ratio [OR], 2.66; 95% CI, 1.34-5.25), history of migraine (OR, 1.90; 95% CI, 1.06-3.39), age ≥50 years (OR, 0.41; 95% CI, 0.23-0.73), history of hypertension (OR, 0.35; 95% CI, 0.20-0.64), and involvement of ≥3 vascular beds (OR, 2.49; 95% CI, 1.15-5.40) were significantly associated with CeAD. To validate the association between CeAD and sex, we performed a systematic review. We collected additional data on sex from 2 published studies and unpublished data from the US Registry for Fibromuscular Dysplasia and the European/International FMD Registry. In the pooled analysis (289 CeAD, 1933 patients), male sex was significantly associated with CeAD (OR, 2.04; 95% CI, 1.41-2.95; I2=0%). Conclusions In patients with FMD, male sex and multisite involvement are associated with CeAD, in addition to other previously known risk factors. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02884141.

Keywords: cervical artery dissection; fibromuscular dysplasia; sex.

Conflict of interest statement

Dr Olin is on the Medical Advisory Board of the Fibromuscular Dysplasia Society of America (no compensation); chair, steering committee, and principal investigator at the United States Registry for Fibromuscular Dysplasia. Dr Touzé is an assistant editor for the Stroke journal, American Heart Association, no compensation. The remaining authors have no disclosures to report.

Figures

Figure 1. Flowchart of the systematic review…
Figure 1. Flowchart of the systematic review on male sex and cervical artery dissection in patients with FMD.
ARCADIA indicates Assessment of Renal and Cervical Artery Dysplasia; and FMD, fibromuscular dysplasia.
Figure 2. Pooled analysis of published and…
Figure 2. Pooled analysis of published and unpublished data on the association between male sex and cervical artery dissection (CeAD) in patients with fibromuscular dysplasia.
ARCADIA indicates Assessment of Renal and Cervical Artery Dysplasia; European/International Registry, European/International FMD Registry; OR, odds ratio; and US FMD Registry, US Registry for Fibromuscular Dysplasia.

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