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Published on: February 5, 2011
Dissection of Cervical and Cerebral Arteries
Stefan T Engelter1,2, Christopher Traenka3, Philippe Lyrer3
1Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland. stefan.engelter@fps-basel.ch.
Insights
Recent research on cervical artery dissection (CeAD) and intracranial artery dissection (IAD) highlights new findings in patient demographics and treatment strategies. Further studies are essential for optimizing acute and long-term management of these conditions.
Area of Science:
- Neurology
- Vascular Medicine
- Genetics
Background:
- Cervical artery dissection (CeAD) and intracranial artery dissection (IAD) are significant causes of stroke, particularly in younger populations.
- Recent studies have expanded our understanding of the demographics and genetic associations of CeAD.
- Acute and preventive treatment strategies for CeAD and IAD remain areas of active investigation.
Purpose of the Study:
- To summarize recent advancements in the research of cervical artery dissection (CeAD) and intracranial artery dissection (IAD).
- To review current findings on patient characteristics, genetic associations, and treatment modalities for CeAD and IAD.
Main Methods:
- Systematic review of recent literature on CeAD and IAD.
- Analysis of population data for CeAD to identify demographic trends.
- Evaluation of current evidence for acute and preventive therapies.
Main Results:
- CeAD affects a broader age range than previously thought, with a notable proportion of patients aged 60 years and older.
- While distinct genetic variants are associated with CeAD, their clinical utility is limited by small effect sizes.
- Both intravenous thrombolysis and endovascular treatment are considered for acute CeAD stroke, though optimal patient selection requires further research.
- The optimal antithrombotic strategy for stroke prevention in CeAD remains debated, with ongoing trials comparing aspirin and anticoagulants.
- Non-vitamin-K oral anticoagulants are not recommended for CeAD outside of clinical trials due to limited data.
- Caution is advised with antithrombotic therapy in IAD due to the risk of intracranial hemorrhage.
Conclusions:
- Knowledge regarding CeAD and IAD has significantly progressed, particularly concerning patient demographics and genetic factors.
- Further research is crucial to elucidate the pathophysiology, refine acute treatment protocols, and establish optimal stroke prevention strategies for CeAD and IAD.
- Long-term outcomes and prognosis for patients with CeAD and IAD require continued investigation.
Purpose Of Review:
We aimed to summarize recent findings in cervical (CeAD) and intracranial artery dissection (IAD) research.
Recent Findings:
Considered a disease of the young- and middle-aged, an analysis on the largest CeAD-population to date (n = 2391) revealed that about 1 of 14 CeAD-patients was aged ≥60 years. Distinct genetic variants were associated with CeAD. However, in clinical practice, genetic investigations are not helpful due to the small effect size. Despite the paucity of data from randomized-controlled trials in CeAD-stroke patients, both intravenous thrombolysis and endovascular treatment should be considered as acute treatment in such patients. Future research is needed to clarify which patients benefit most from each treatment modality. Whether to use antiplatelets or anticoagulants in stroke prevention in CeAD-patients is still a matter of debate. One randomized-controlled feasibility trial has been published, and another trial designed to show non-inferiority of aspirin to vitamin-K-antagonists is underway and will be terminated in late 2018. Non-vitamin-K-oral anticoagulants should not be used in CeAD outside a properly designed trial, as experience with these drugs in CeAD-patients is limited. With many IAD patients developing intracranial hemorrhage, antithrombotic therapy should be used with caution. Knowledge about CeAD and IAD has advanced substantially. Nevertheless, further research is mandatory, in particular regarding pathophysiology, acute treatment, and stroke-preventive therapy, as well as long-term outcome and prognosis.
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