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Stroke Prevention in Cervical Artery Dissection

  • Stroke (DL Tirschwell, Section Editor)
  • Published:
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A Correction to this article was published on 13 January 2022

This article has been updated

Abstract

Purpose of Review

Cervical artery dissection (CAD) is rare, yet it is a common cause of stroke in young and middle-aged adults. Historically, some senior clinicians favored anticoagulation in the prevention of stroke due to CAD. Choosing the optimal antithrombotic treatment with either antiplatelet (AP) or anticoagulant (AC) medications remains a challenge. This paper will review the clinical features and imaging of CAD, and the acute treatment and prevention of stroke due to CAD.

Recent Findings

Until 2015, there were no prospective randomized trials in the optimal antithrombotic management of CAD. The Cervical Artery Dissection in Stroke Study (CADISS) trial found that treatment with AC did not lower the risk of subsequent stroke or death at 3 months when compared to AP agents. This led to a paradigm shift in national guidelines. In 2021, The Biomarkers and Antithrombotic Treatment in of Cervical Artery Dissection (TREAT-CAD) trial however did not confirm the non-inferiority of AP therapy in stroke prevention due to CAD.

Summary

The optimal antithrombotic management for stroke prevention in CAD remains uncertain, while the superiority of anticoagulation has not been established, nor has the non-inferiority of AP agents. The future direction of research should consider early preventative treatment, dual treatment with AP agents, direct oral AC medications, and aggregation of data from existing randomized trials.

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  1. Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, 560153, USA

    Rick Gill & José Biller

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Gill, R., Biller, J. Stroke Prevention in Cervical Artery Dissection. Curr Cardiol Rep 23, 182 (2021). https://doi.org/10.1007/s11886-021-01603-2

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