Diagnosis and treatment of arterial dissections

Area of Science:

• Vascular Neurology
• Neuroradiology
• Trauma Surgery

Background:

• Cervical and intracranial vessel dissections are a significant cause of ischemic stroke in individuals under 50.
• Dissections can be spontaneous or trauma-induced, necessitating prompt diagnosis and management.
• Computed tomographic angiography (CTA) is a sensitive imaging modality for diagnosing these dissections.

Purpose of the Study:

• To review the diagnostic modalities and treatment strategies for cervical and intracranial vessel dissections.
• To emphasize the importance of timely diagnosis and individualized patient management.
• To discuss the role of antiplatelet therapy, anticoagulation, and endovascular interventions.

Main Methods:

• Review of current literature on cervical and intracranial vessel dissections.
• Analysis of diagnostic accuracy of computed tomographic angiography.
• Evaluation of treatment outcomes for various therapeutic approaches.

Main Results:

• Computed tomographic angiography demonstrates high sensitivity for detecting vessel dissections.
• Treatment strategies include antiplatelet agents, anticoagulation, and endovascular interventions.
• No single medical treatment shows superiority; aspirin monotherapy can be effective.
• Endovascular intervention is indicated for specific complications like significant stenosis or pseudoaneurysms.

Conclusions:

• Early diagnosis of cervical and intracranial vessel dissections using CTA is critical.
• Individualized treatment selection is paramount, with antiplatelet therapy often sufficient.
• Endovascular options are reserved for complex cases and specific complications.
• Management requires careful consideration, especially in polytrauma patients.