Cervical Artery Dissection: A Review of the Epidemiology, Pathophysiology, Treatment, and Outcome
Christina A Blum1, Shadi Yaghi2
1University of Pennsylvania Health System, Department of Neurology, Stroke division.
Insights
Cervical artery dissection (CAD) is a leading cause of stroke in young adults. Current evidence does not show a difference between anticoagulation and antiplatelet therapy for stroke prevention in CAD patients.
Area of Science:
- Neurology
- Vascular Medicine
Background:
- Cervical artery dissection (CAD) is a significant cause of stroke, particularly in young adults.
- The optimal antithrombotic treatment for CAD remains controversial, with ongoing debate regarding anticoagulation versus antiplatelet therapy.
- Existing meta-analyses have not demonstrated a significant difference in stroke prevention between these two treatment modalities.
Purpose of the Study:
- To review the current understanding of cervical artery dissection, including its mechanisms, clinical presentation, and management.
- To synthesize evidence regarding the efficacy of anticoagulation versus antiplatelet therapy in preventing stroke in CAD patients.
Main Methods:
- A comprehensive PubMed search was conducted for articles published between January 1, 1990, and July 1, 2015.
- Keywords included "Cervical artery dissection", "Dissection", "Carotid dissection", and "Vertebral dissection".
- Evidence-based peer-reviewed articles, encompassing randomized trials, case series, case reports, and retrospective reviews, were identified and analyzed.
Main Results:
- The review highlights the underlying mechanisms of cervical artery dissection and associated stroke.
- It also provides insights into the natural history and current treatment strategies for CAD.
- The paper underscores the lack of demonstrated superiority of one antithrombotic treatment over the other in preventing stroke.
Conclusions:
- Multicenter studies and international collaboration are essential due to the rarity of cervical artery dissection.
- Randomized controlled trials are needed to definitively compare anticoagulation and antiplatelet therapy in CAD patients.
- Such collaborative efforts will facilitate robust evidence generation for optimal patient management.
Context:
Cervical artery dissection (CAD) is a common cause of stroke in young adults. There is controversy over whether anticoagulation is superior to antiplatelet therapy in preventing stroke in patients with CAD, although meta-analyses to date have not shown any difference between the two treatments.
Evidence Acquisition:
We performed a PubMed search using each of the keywords: "Cervical artery dissection", "Dissection", "Carotid dissection", and "Vertebral dissection" between January 1st, 1990 and July 1st 2015. We identified evidence-based peer-reviewed articles, including randomized trials, case series and reports, and retrospective reviews that encompass the epidemiology, clinical manifestations, pathophysiology, treatment, and outcome of cervical artery dissection.
Results:
This paper highlights the mechanisms of cervical artery dissection and stroke in patients with dissection as well as the natural history and treatment.
Conclusion:
Given the relatively rare incidence of this disease, multicenter studies with collaborative effort among stroke centers worldwide should be considered to enroll patients with cervical artery dissection in a randomized trial comparing the two treatments.
