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Dissection of Cervical and Cerebral Arteries

  • Stroke (H Diener, Section Editor)
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Abstract

Purpose of Review

We aimed to summarize recent findings in cervical (CeAD) and intracranial artery dissection (IAD) research.

Recent Findings

Considered a disease of the young- and middle-aged, an analysis on the largest CeAD-population to date (n = 2391) revealed that about 1 of 14 CeAD-patients was aged ≥60 years. Distinct genetic variants were associated with CeAD. However, in clinical practice, genetic investigations are not helpful due to the small effect size. Despite the paucity of data from randomized-controlled trials in CeAD-stroke patients, both intravenous thrombolysis and endovascular treatment should be considered as acute treatment in such patients. Future research is needed to clarify which patients benefit most from each treatment modality. Whether to use antiplatelets or anticoagulants in stroke prevention in CeAD-patients is still a matter of debate. One randomized-controlled feasibility trial has been published, and another trial designed to show non-inferiority of aspirin to vitamin-K-antagonists is underway and will be terminated in late 2018. Non-vitamin-K-oral anticoagulants should not be used in CeAD outside a properly designed trial, as experience with these drugs in CeAD-patients is limited. With many IAD patients developing intracranial hemorrhage, antithrombotic therapy should be used with caution.

Summary

Knowledge about CeAD and IAD has advanced substantially. Nevertheless, further research is mandatory, in particular regarding pathophysiology, acute treatment, and stroke-preventive therapy, as well as long-term outcome and prognosis.

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Correspondence to Stefan T. Engelter.

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Conflict of Interest

Stefan T. Engelter has received funding for travel or speaker honoraria from Bayer and Boehringer Ingelheim; he has served on scientific advisory boards for Bayer, Boehringer Ingelheim, BMS/Pfizer, and Covidien and on the editorial board of Stroke. He has received an educational grant from Pfizer and research support from the Science Funds (Wissenschaftsfonds) of the University Hospital Basel, the University Basel, the Swiss Heart Foundation, and the Swiss National Science Foundation.

Christopher Traenka has received funding from the Swiss Heart Foundation and was supported by the Swiss National Science Foundation and has been granted research support from the University Basel.

Philippe Lyrer has served on scientific advisory boards for Bayer Schering Pharma and Boehringer Ingelheim; has received funding for travel or speaker honoraria from Bayer Schering Pharma, Boehringer Ingelheim, and Shire plc; serves as coeditor for Neurologie und Psychiatrie and on the editorial board of Swiss Archives of Neurology and Psychiatry; and has received research support from AstraZeneca, Boehringer Ingelheim, Sanofi-Aventis, PhotoThera, the Swiss National Science Foundation, and the Swiss Heart Foundation.

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Engelter, S.T., Traenka, C. & Lyrer, P. Dissection of Cervical and Cerebral Arteries. Curr Neurol Neurosci Rep 17, 59 (2017). https://doi.org/10.1007/s11910-017-0769-3

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