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cervical artery dissection

Classification: - carotid artery dissection - vertebral artery dissection - basilar artery dissection Etiology: - risk factors - hypercholesterolemia - hypertension - diabetes mellitus [3] Clinical manifestations: - Horner syndrome - patients >= 60 years of age less likely to present with cervical pain (RR=0.47), headache (RR=0.58), or history of mechanical triggers (RR=0.53) [3] Complications: - elderly >= 60 years of age associated with less favorable outcomes [3] Management: - aspirin is not non-inferior to vitamin K antagonist (warfarin) [4] - anticoagulants & antiplatelet agents similarly effective in preventing recurrent events [5]

Specific

carotid artery dissection vertebral artery dissection

References

  1. The CADISS trial investigators. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): A randomised trial. Lancet Neurol 2015 Feb 12 PMID: 25684164 http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2815%2970018-9/abstract
  2. Kennedy F, Lanfranconi S, Hicks C et al Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 2012 Aug 14;79(7):686-9. PMID: 22855862
  3. Traenka C, Dougoud D, Simonetti BG et al. Cervical artery dissection in patients >= 60 years: Often painless, few mechanical triggers. Neurology 2017 Apr 4; 88:1313 PMID: 28258079 http://www.neurology.org/content/88/14/1313
  4. Engelter ST et al. Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): An open-label, randomised, non-inferiority trial. Lancet Neurol 2021 Mar 22; [e-pub]. PMID: 33765420 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(21)00044-2/fulltext
  5. Kaufmann JE et al. Antithrombotic treatment for cervical artery dissection: A systematic review and individual patient data meta-analysis. JAMA Neurol 2024 Jun; 81:630. PMID: 38739383 PMCID: PMC11091821 (available on 2025-05-13) https://jamanetwork.com/journals/jamaneurology/fullarticle/2818521