{"id":"6bcfe08b3b44","type":"article","url":"https://hartvaat.nl/2026/05/19/stop-cad-1-op-6-cervicale-arteriedissecties-wordt-aanvankelijk-verkeerd-gediagno/","title":"STOP-CAD: 1 op 6 cervicale arteriedissecties wordt aanvankelijk verkeerd gediagnosticeerd","title_en":"","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American Heart Association","doi":"10.1161/JAHA.125.046408","source_url":"https://doi.org/10.1161/JAHA.125.046408","authors":["Ekaterina Bakradze","Liqi Shu","Shadi Yaghi","Thanh Lam Ngoc Tran","Ross Curtiss Crandal","Evan Lester","Daniel M Mandel","James Ernest Siegler","Mary Penckofer","Ava Leigh Liberman","Thalia S Field","Farhan Khan","Wayneho Kam","Brian Mac Grory","Faddi G Saleh Velez","Nils Henninger","Cheran Elangovan","Balaji Krishnaiah","Preet Gandhi","Reza Bavarsad Shahripour","Malik Ghannam","Mirjam Rachel Heldner","Kateryna Antonenko","Aaron Rothstein","Ronen R Leker","Issa Metanis","Edgar Samaniego","Michele Romoli","Marialuisa Zedde","Rosario Pascarella","Thanh N Nguyen","Piers Klein","Farid Khasiyev","Ossama Khazaal","Mohammad Almajali","Adeel S Zubair","Marwa Elnazeir","João Pedro Marto","Ahmad Nehme","James Anthony Giles","Stefan T Engelter","Christoph Stretz","Setareh Salehi Omran"],"significance":6,"published":"2026-06-10","source_date":"2026-05-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"Secondary analysis of the STOP-CAD study in 4,012 patients with cervical artery dissection (CeAD; mean age 47.5 years; 44.6% female). Possible diagnostic error — defined as CeAD symptoms within 30 days before the eventual diagnosis — occurred in 663 (16.5%); 33.8% of these had an ischaemic stroke before diagnosis. Patients with diagnostic delay were younger (OR 0.89), more often had a migraine history (OR 1.35) and presented with headache (OR 1.43) but less often with focal neurological signs (OR 0.68). After adjustment, there were no differences in ischaemic stroke after diagnosis, 90-day mRS <2 or mortality between groups. Heightened differential-diagnostic awareness in younger patients with headache (especially with migraine history) and no focal signs could speed diagnosis.","created":"2026-07-03T10:33:01Z","updated":"2026-07-03T13:31:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Secundaire analyse van de STOP-CAD-studie bij 4.012 patiënten met cervicale arteriedissectie (CeAD; gemiddelde leeftijd 47,5 jaar; 44,6% vrouw). Mogelijke diagnostische fout — gedefinieerd als CeAD-symptomen in de 30 dagen vóór de uiteindelijke diagnose — kwam voor bij 663 (16,5%); 33,8% van hen had op dat moment al een ischemisch CVA. Patiënten met diagnostische vertraging waren jonger (OR 0,89), hadden vaker een migraine-historie (OR 1,35) en presenteerden zich vaker met hoofdpijn (OR 1,43) maar minder met focale neurologische verschijnselen (OR 0,68). Na correctie waren er geen verschillen in ischemisch CVA na diagnose, 90-daagse mRS <2 of mortaliteit tussen beide groepen. Differentiaaldiagnostische alertheid bij jongere patiënten met hoofdpijn (zeker met migraine-historie) zonder focale tekenen kan diagnose versnellen.","abstract_original":"BACKGROUND: Cervical artery dissection (CeAD) is a common cause of stroke in young adults but is frequently misdiagnosed due to its nonspecific symptoms. This study examines factors associated with possible diagnostic error in CeAD and evaluates its impact on patient outcomes. METHODS: We conducted a secondary analysis of the STOP-CAD (Antithrombotic Therapy for Stroke Prevention in Cervical Artery Dissection) study, which is a multicenter international study of adult patients admitted with CeAD. Possible diagnostic error was defined as the presence of CeAD symptoms within 30 days before the index CeAD diagnosis. The comparison group included patients diagnosed on their first medical encounter. Multivariable regression was used to identify factors associated with possible diagnostic error. Primary and secondary outcomes included ischemic stroke, death, and modified Rankin Scale score <2. RESULTS: Of 4012 patients (mean age 47.5 years, 44.6% female), 663 (16.5%) experienced possible diagnostic error. Among these, 224 (33.8%) reported to have ischemic stroke before CeAD diagnosis. Patients with possible diagnostic error were younger (odds ratio [OR], 0.89, P<0.001), more likely to have a history of migraines (OR, 1.35, P=0.007), and more likely to present with headaches (OR, 1.43, P<0.001), but less likely to show focal neurologic signs (OR, 0.68, P<0.001). There was no significant difference between groups in ischemic stroke after diagnosis (adjusted OR, 0.96, P=0.86), 90-day modified Rankin Scale score <2 (adjusted OR, 1.04, P=0.80), or death (adjusted OR, 0.58, P=0.34). CONCLUSIONS: One in 6 patients with CeAD experienced a possible diagnostic error, particularly those who were younger, had migraines, or presented with headaches and nonfocal symptoms."}