WSO - April 2023 - 433

1156081
WSO
International Journal of StrokeMayer-Suess et al.
Research
Decline in spontaneous cervical artery
dissection incidence during COVID-19
public health measures: Evidence for
a role of upper respiratory infections
in pathogenesis
Lukas Mayer-Suess1 , Anna Heidbreder1,
Stefan Kiechl1,2 and Michael Knoflach1,2
Abstract
Background: Upper respiratory infections have been suggested as a risk factor for spontaneous cervical artery dissection
(sCeAD). If this is the case, public health measures implemented to contain the spread of SARS-CoV-2, which also
reduced other communicable diseases such as influenza, might be associated with a reduction in cervical artery dissection
incidence.
Aims: We determined the incidence of sCeAD before, during and after the COVID-19 pandemic, and the associated
public health measures.
Methods: All patients suffering an sCeAD and seen in Innsbruck Austria, between January 2002 to December 2016
(pre-COVID comparators) and between January 2020 to August 2022 were recorded through two individual prospective
cohort studies. We compared admission rates, demographic, and clinical characteristics of sCeAD patients in preCOVID-19
and COVID-19 times.
Results: In total, 249 sCeAD patients were admitted prior to the COVID-19 pandemic compared to 20 during its
course. Baseline characteristics of sCeAD subjects did not differ in subjects admitted during and prior to the pandemic.
Following the introduction of public health measures for the pandemic, there was a marked decrease of sCeAD admissions
from 16.5 per year to 6.3 per year (p = 0.012). Since the measures were ended the number of sCeAD admissions
increased again. In contrast, the number of all ischemic stroke patients treated at the Medical University of Innsbruck
did not alter during the pandemic. (N per year: 633 in 2015, 687 in 2017, 684 in 2019, 731 in 2020, and 717 in 2021).
Conclusion: The incidence of sCeAD fell markedly during the pandemic and this may have resulted from the public
health measures introduced and a subsequent reduction in upper respiratory infections. Our study provides indirect
evidence for a role of infection in the pathogenesis of sCeAD.
Data access statement: Anonymized data not published within this article will be made available by request from any
qualified investigator.
Keywords
COVID-19, measures, cervical artery dissection, stroke
Received: 25 November 2022; accepted: 15 January 2023
Introduction
Measures to contain the spread of SARS-CoV-2 have had
an impact on acute management of vascular emergencies
globally.1-8 In turn, these measures, be they lockdown periods
or face mask-mandates, have, at least intermittently, hit
their mark in preventing the virus spread.9 As the months
1 Department of Neurology, Medical University of Innsbruck, Innsbruck,
Austria
2VASCage, Innsbruck, Austria
Corresponding author:
Lukas Mayer-Suess, Department of Neurology, Medical University of
Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria.
Email: lukas.mayer@i-med.ac.at
International Journal of Stroke, 18(4)
International Journal of Stroke
2023, Vol. 18(4) 433 -436
© 2023 World Stroke Organization
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DOI: 10.1177/17474930231156081
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