Diagnosis and treatment of cervical artery dissection

Neurol Clin. 2015 May;33(2):421-41. doi: 10.1016/j.ncl.2014.12.002.

Abstract

Cervical artery dissection (CAD) is a major cause of stroke in the young. A mural hematoma is detected in most CAD patients. The intramural blood accumulation should not be considered a reason to withhold intravenous thrombolysis in patients with CAD-related stroke. Because intravenous-thrombolyzed CAD patients might not recover as well as other stroke patients, acute endovascular treatment is an alternative. Regarding the choice of antithrombotic agents, this article discusses the findings of 4 meta-analyses across observational data, the current status of 3 randomized controlled trials, and arguments and counterarguments favoring anticoagulants over antiplatelets. Furthermore, the role of stenting and surgery is addressed.

Keywords: Anticoagulants; Antipatelets; Cervical artery dissection; Endovascular treatment; IV thrombolysis; Stroke; Surgery.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Aortic Dissection / diagnosis*
  • Aortic Dissection / therapy*
  • Arteries / pathology
  • Brain / blood supply*
  • Endovascular Procedures
  • Fibrinolytic Agents / therapeutic use
  • Humans

Substances

  • Anticoagulants
  • Fibrinolytic Agents