Delayed occlusion after internal carotid artery dissection under heparin

Area of Science:

• Neurology
• Vascular Medicine
• Cardiology

Background:

• Internal carotid artery dissection (ICAD) is a common cause of stroke in young adults.
• Anticoagulation with unfractionated heparin is standard treatment for ICAD.
• A potential complication of unfractionated heparin is increased intramural hematoma, potentially causing cerebral infarction.

Purpose of the Study:

• To investigate the association between unfractionated heparin treatment and intramural hematoma expansion in ICAD patients.
• To determine if activated partial thromboplastin time (aPTT) ratios correlate with delayed internal carotid artery (ICA) occlusion.
• To inform the ongoing debate regarding anticoagulant versus antiplatelet therapy for ICAD.

Main Methods:

• Prospective monitoring of 20 ICAD patients treated with unfractionated heparin.
• Twice-daily measurement of activated partial thromboplastin time (aPTT) ratios.
• Repeated ultrasound assessments to monitor ICAD progression and detect delayed ICA occlusion.

Main Results:

• Delayed internal carotid artery (ICA) occlusion occurred in 5 of 20 patients during unfractionated heparin treatment.
• One patient with delayed occlusion developed a watershed infarct.
• Patients experiencing delayed occlusion exhibited significantly higher aPTT ratios (2.6 +/- 0.4) compared to those without occlusion (2.0 +/- 0.5).

Conclusions:

• Unfractionated heparin treatment for ICAD may be associated with increased intramural hematoma.
• Elevated aPTT ratios during the initial 6 days post-diagnosis may predict delayed ICA occlusion.
• Further randomized clinical trials are warranted to clarify the optimal antithrombotic strategy for ICAD.