Spontaneous cerebral and cervical artery dissection: Treatment and prognosis
- David S Liebeskind, MD
David S Liebeskind, MD
- Professor of Neurology
- University of California, Los Angeles
- Jeffrey Saver, MD
Jeffrey Saver, MD
- Professor of Neurology
- Geffen School of Medicine at UCLA
Arterial dissections are a common cause of stroke in the young, but may occur at any age. Dissection occurs when structural integrity of the arterial wall is compromised, allowing blood to collect between layers as an intramural hematoma.
This topic will review the treatment and prognosis of spontaneous cerebral and cervical artery dissection. Other aspects of this disorder are reviewed separately. (See "Spontaneous cerebral and cervical artery dissection: Clinical features and diagnosis".)
The available evidence suggests that treatment with thrombolytic therapy should not be withheld for eligible patients with very early acute ischemic stroke due to extracranial cervical artery dissection (see 'Thrombolysis' below). Beyond the hyperacute period, antithrombotic therapy with either anticoagulation or antiplatelet drugs is accepted treatment for ischemic stroke and transient ischemic attack (TIA) caused by extracranial artery dissection, although there is controversy regarding the choice between the two (see 'Antithrombotic therapy' below). In addition, there is controversy regarding the use of thrombolytics and antithrombotic agents for ischemic symptoms in patients with either intracranial dissection alone or intracranial extension of extracranial dissection because of the presumed increased risk of subarachnoid hemorrhage.
Less often, endovascular methods or surgical repair have been used to treat dissection, mainly for patients who have recurrent ischemia despite antithrombotic therapy (see 'Endovascular and surgical therapy' below).
Optimal treatment of dissection remains a challenge due to limitations in rapidly establishing a definitive diagnosis, the overall low incidence, low recurrence rate, and marked variation in patient characteristics .
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- ACUTE ISCHEMIA
- Endovascular methods
- ANTITHROMBOTIC THERAPY
- Duration of antithrombotic therapy
- Endovascular and surgical therapy
- Choosing therapy for primary and secondary prevention of ischemia
- MANAGEMENT OF LOCAL SYMPTOMS
- MANAGEMENT OF SUBARACHNOID HEMORRHAGE
- RISK REDUCTION
- Vessel healing
- SUMMARY AND RECOMMENDATIONS