Combined Anticoagulation and Antiaggregation in Acute Cervical Artery Dissection.

Philipp Von Gottberg,Ludwig Niehaus,Hans Henkes,Marc E Wolf,Christina Wendl,Victoria Hellstern,Hansjörg Bäzner

doi:10.3390/jcm10194580

Abstract

Cervical artery dissection (CAD) is a frequent cause of stroke in young adults. Previous studies investigating the efficiency of anticoagulation (AC) versus antiplatelet therapy (AT) found an insignificant difference. We therefore retrospectively evaluated a combination of AC plus AT in patients with acute CAD regarding safety and efficacy. Twenty-eight patients with CAD and minor neurological symptoms/no major infarction received either single (n = 14) or dual AT (n = 14) combined with AC. Angiographic follow-up during hospitalization, 4-8 weeks and 3–6 months after CAD focused on occlusion, residual stenosis, and functional recanalization. Possible adverse events were surveyed. We compared the AC plus AT group to 22 patients with acute CAD treated with AC or AT. Compared to preceding AC-/AT-only studies, AC plus single or dual AT resulted in more frequent, faster recanalization. Frequency and severity of adverse events was comparable. No major adverse events or death occurred. Preceding works on conservative treatment of CAD are discussed and compared to this study. Considerations are given to pathophysiology and the dynamic of CAD. Combining AC plus AT in CAD may result in more reliable recanalization in a shorter time. The risk for adverse events appears similar to treatment with only AC or AT.

Highlights

A common cause of stroke in young and middle-aged adults is a spontaneous dissection of the cervical carotid or vertebral artery, which accounts for 10–25% of all strokes in patients with a mean age of 45 years [1,2,3,4,5]
In a population with young patients who have sustained a minor ischemic stroke, the bleeding risk is probably low, and a combined AC–AT strategy could be more effective than single therapy with either AC or AT
There were n = 50 patients with acute dissections of the cervical carotid or vertebral artery, and without an associated pseudoaneurysm who qualified for conservative management either due to minor neurological symptoms (NIHSS < 3, derived from clinical records) or endovascular non-accessibility with good collateralization

Summary

Introduction

A common cause of stroke in young and middle-aged adults is a spontaneous dissection of the cervical carotid or vertebral artery, which accounts for 10–25% of all strokes in patients with a mean age of 45 years [1,2,3,4,5]. The primary risk factors for developing a carotid or vertebral artery dissection include current smoking (30–40%), dyslipidemia/hypercholesterolemia (19–40%), arterial hypertension (aHT, 25%), and a history of vascular disease (4%). The untreated dissection of an internal carotid (ICA) or vertebral artery (VA) is associated with a 70–80% incidence of developing an ischemic stroke [8,11]. In a population with young patients who have sustained a minor ischemic stroke (or TIA or just local dissection), the bleeding risk is probably low, and a combined AC–AT strategy could be more effective than single therapy with either AC or AT

Methods

Discussion

Conclusion