Treatment of cervical artery dissections

Abstract

Cervical artery dissection (CeAD) is an important cause of ischemic stroke in young adults with ischemic stroke. The clinical manifestations are often local facial pain, Horner syndrome, and ischemic stroke. With the development of noninvasive imaging, many patients with CeAD have got early diagnosis. Thromboembolism is an important mechanism of its pathogenesis. Timely giving anticoagulation therapy is reasonable. However, anticoagulants may lead to intramural hematoma expansion; therefore, there are also people who support antiplatelet therapy. However, the effectiveness of the 2 regimens needs to be confirmed by randomized trials. The recently completed Cervical Artery Dissection in Stroke Study (CADISS) in patients with stroke is the first prospective study aiming at the problem. The results have showed that there was no significant difference in efficacy between the anticoagulants and the antiplatelet drugs. Thrombolysis in patients with acute CeAD can not increase the risks of hemorrhage, and the rate of good functional outcome is similar to that of the control group. Therefore, it can be used as a treatment method in acute phase. For patients whose antithrombotic treatment is invalid or having contraindications and repeated recurrent stroke can conduct endovascular intervention or surgical treatment. Usually, the prognosis of patients with CeAD is better. The stroke recurrence rate is low. The abnormal arterial walls in more than half of the patients will disappear at 3 to 6 months. Key words: Carotid Artery, Internal, Dissection; Vertebral Artery Dissection; Stroke; Brain Ischemia; Anticoagulants; Platelet Aggregation Inhibitors; Thrombolytic Therapy; Stents