Management of spontaneous dissection of the cervical carotid artery

Area of Science:

• Neurology
• Vascular Surgery
• Internal Medicine

Background:

• Spontaneous dissection of the cervical internal carotid artery (sICAD) is a significant cause of stroke, particularly in younger adults.
• Current management strategies are primarily based on observational data and case reports, lacking high-level evidence from randomized controlled trials.

Purpose of the Study:

• To review the current management strategies for patients diagnosed with spontaneous dissection of the cervical internal carotid artery (sICAD).
• To synthesize available evidence regarding stroke prevention, treatment efficacy, and the role of thrombolysis in sICAD.

Main Methods:

• A comprehensive review of existing literature, including case-control studies, observational studies, and case reports on sICAD management.
• Analysis of data on vascular risk factors, stroke prevention methods (aspirin vs. anticoagulation), conservative management, and thrombolysis outcomes.

Main Results:

• Vascular risk factors in sICAD patients appear similar to the general population.
• Oral aspirin may offer comparable stroke prevention to anticoagulation.
• Most sICAD cases with severe stenosis, occlusion, or aneurysm can be managed conservatively.
• Intravenous thrombolysis with tissue plasminogen activator shows potential benefit, while intra-arterial thrombolysis efficacy remains uncertain.

Conclusions:

• Conservative management and antiplatelet therapy (aspirin) are often effective for sICAD.
• Intravenous thrombolysis may be beneficial in select cases, but further research is needed.
• High-quality evidence from randomized trials is required to definitively guide sICAD management.