In patients with autosomal dominant polycystic kidney disease (ADPKD), key clinical features were associated with the risk for concomitant cervical artery dissection in a retrospective observational study.

“Our study shows that the presence of certain clinical features in ADPKD patients, such as acute ischemic stroke, aortic and coronary artery dissections, and coagulation defects, can be associated with cervical artery dissection, and thus, screening should be considered,” wrote the authors of the study, which was recently published in Medicina.

“To our knowledge, the previous literature of [cervical artery dissection in ADPKD] has been primarily case-based, making our study of associated clinical features unique given our large, national cohort,” they added. “Recognition of these comorbidities should inform clinical decision-making regarding vascular screening in this population.”

ADPKD, a multisystem disorder that is the most common hereditary renal disease, is characterized by a loss of polycystin function, resulting in cystic and vascular manifestations such as bilateral renal cysts, hypertension, aortic root dilation, and intracranial aneurysms.

The disease can be life-threatening, with mortality rates of 18.4 deaths per 1000 patient years among those with ADPKD and chronic kidney disease and 37.4 deaths per 1000 patient years among those with end-stage renal disease (ESRD), the authors noted.

Cervical artery dissection, which occurs in internal carotid or vertebral arteries, has been reported to co-occur with ADPKD, and, though rare, the two together pose an increased risk for complications.

Causes and Clinical Features

To better understand the underlying causes and clinical features associated with concomitant cervical artery dissection in ADPKD, first author Anna Liu, MD, of the Department of Neurology, Mayo Clinic in Rochester, Minnesota, and colleagues conducted a retrospective, observational study based on the National Inpatient Sample between 2016 and 2020.

The researchers identified 224,065 patients with ADPKD and 86,135 patients with cervical artery dissections in the database. Overall, 155 patients (0.05%) had both ADPKD and cervical artery dissections. These patients had a mean age of 56.74 years; 47% were female, and 66% were White.

Leading risk factors found to be significantly associated with the development of cervical artery dissections in patients with ADPKD were comorbid acute ischemic stroke (P < .001), transient ischemic attack (P < .001), aortic dissection (P < .001), coronary artery dissection (P < .001), subarachnoid hemorrhage (P < .001), coagulation defects (P = .002), and hypertension (P < .001).

Conversely, among those with cervical artery dissections, factors that were significantly associated with ADPKD included a concomitant diagnosis of coronary artery dissection (P = .003), carotid aneurysm (P = .004), subarachnoid hemorrhage (P = .028), complicated hypertension (P < .001), coagulation defects (P = .022), ESRD (P < .001), blood loss anemia (P = .032), or lymphoma (P = .012).

In addition, certain treatments were associated with the two conditions — those with ADPKD who underwent coiling or fluoroscopy or digital subtraction angiography were more likely to have concurrent cervical artery dissections (P < .001).

And those with cervical artery dissections requiring endovascular clipping for management of intracranial aneurysms had increased rates of ADPKD (P < .001).

Of note, no significant association was observed between the long-term use of antiplatelets or anticoagulant medications and a concurrent diagnosis of either ADPKD or cervical artery dissection.

Previous studies have shown patients with ADPKD to have a fivefold to ninefold increased risk for aortic dissection than the general population, with incidence higher among patients with hypertension and progression of chronic kidney disease.

However, “it should be noted that dissections and aneurysms of almost every large artery have been documented,” the authors wrote.

While there is currently no consensus regarding screening for potential cervical artery dissection in patients with ADPKD, the study’s identification of key risk factors “underscores the importance of comorbid conditions that may predispose a patient to cervical artery dissections,” they concluded.

The authors reported having no disclosures.