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Cervical arterial dissection: time for a therapeutic trial?
Vadim Beletsky1, Zurab Nadareishvili, John Lynch
1University of Western Ontario, London, Ontario, Canada. vados@imaging.robarts.ca
Stroke
|November 8, 2003
Summary
Cervical arterial dissection in young adults has a high initial recurrence rate. A large multicenter trial comparing anticoagulants and aspirin is feasible to determine optimal treatment for stroke prevention.
Area of Science:
- Neurology
- Vascular Medicine
- Stroke Research
Background:
- Cervical arterial dissection is a leading cause of stroke in young adults.
- Current management with anticoagulants or antiplatelet drugs lacks definitive evidence.
- Uncertainty exists regarding the optimal treatment strategy.
Purpose of the Study:
- To evaluate the natural history of cervical arterial dissection.
- To determine the feasibility of conducting a therapeutic trial for this condition.
Main Methods:
- Prospective enrollment of patients with angiographically proven acute vertebral or carotid arterial dissection.
- Data collection on clinical and radiological features, and treatment details.
- 1-year follow-up to assess recurrence of ischemic events.
Main Results:
- 116 patients (67 vertebral, 49 carotid dissections) were analyzed.
- 15% of patients experienced recurrent ischemic events (TIA, stroke, death) within 1 year.
- No significant difference in event rates between anticoagulant (8.3%) and aspirin (12.4%) treatment groups.
Conclusions:
- Cervical arterial dissection exhibits a relatively high initial recurrence rate.
- A multicenter trial comparing anticoagulants and aspirin, requiring approximately 2000 patients, is feasible.
- This study provides data to support future clinical trials for optimizing stroke prevention.