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Spontaneous arterial dissection

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Opinion statement

  • There is no controlled study for the best treatment or management of cervicocerebral artery dissection (CAD).

  • Rationale initial empiric treatment in acute CAD to prevent secondary embolism is partial thromboplastin time (PTT)-guided anticoagulation by intravenous heparin followed by anticoagulation with warfarin.

  • Carotid surgery for treatment of CAD is not recommended anymore with the possible exception of persisting severe stenosis of the proximal internal carotid artery (ICA).

  • There could be use of carotid angioplasty by balloon dilatation and stenting in selected cases of severe cerebral hemodynamic impairment by bilateral CAD.

  • Duration of secondary prophylaxis by anticoagulation is best guided by Doppler sonography follow-up, and should be continued until normalization of blood flow or until at least 1 year after the vessel is occluded.

  • There is no evidence that pseudoaneurysms increase the risk for embolic complication, and there is no evidence for surgery or continuation of anticoagulation in patients with pseudoaneurysms.

  • Caution should be recommended for exercises that involve excessive head movements (eg, bungee jumping, trampoline jumping, and chiropractic maneuvers).

  • The patient should be informed that recurrent rate is low in nonfamilial cases.

  • Doppler sonography is a low-cost and high-sensitivity method for patients at risk.

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Authors and Affiliations

  1. Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany

    Tobias Brandt MD

Authors
  1. Tobias Brandt MD
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  2. Louis Caplan MD
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Brandt, T., Caplan, L. Spontaneous arterial dissection. Curr Treat Options Neurol 3, 463–469 (2001). https://doi.org/10.1007/s11940-001-0034-5

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  • DOI: https://doi.org/10.1007/s11940-001-0034-5

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