Postacute C-reactive protein levels are elevated in cervical artery dissection

Background and Purpose - C-reactive protein (CRP) is associated with atherogenesis and stroke in mostly elderly subjects. We tested whether elevated CRP may also be linked to spontaneous cervical artery dissection ( CAD) and cryptogenic stroke. Methods - We investigated high-sensitivity CRP levels in 62 patients < 60 years of age experiencing cerebral ischemia resulting from large artery atherosclerosis (LAA; n = 21), CAD ( n = 21), or cryptogenic etiology ( n = 20) > 9 months ago, and in 54 sex- and age-matched population controls. Receiver operating characteristic curve was used to identify the best CRP cutoff level for dichotomization. Results - CRP was elevated above control levels (0.54 [ 0.33 to 0.84] median, interquartile range mg/L) in patients with LAA (2.59 [ 0.56 to 3.99] mg/L; P < 0.001) and with CAD (2.37 [ 0.57 to 4.78] mg/L; P = 0.0013) but not in patients with cryptogenic etiology ( 0.74 [0.14 to 7.86] mg/L). CRP levels above the cutoff level of 0.71 mg/L were independently associated with former CAD ( P = 0.005) but not with former LAA after adjustment for age, gender, and conventional risk factors. Conclusion - Our results strongly suggest that CRP is associated with CAD, independent from conventional risk factors, and that inflammatory mechanisms may play a role in its pathogenesis. This finding should be confirmed by larger studies.