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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
- 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
- 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
- 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
- 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
- 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