Non-traumatic cervical artery dissection and ischemic stroke: A narrative review of recent research
Michał Marciniec1, Klaudia Sapko1, Marcin Kulczyński1
1Chair and Department of Neurology, Medical University of Lublin, Poland.
Insights
Cervical artery dissection (CAD) is a common cause of stroke in younger adults, often presenting with varied symptoms. Recent advancements focus on MRI for diagnosis and equivalent antiplatelet/anticoagulant therapies, with endovascular options for complex cases.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Cervical artery dissection (CAD) is a significant cause of ischemic stroke (IS) in young and middle-aged individuals.
- Diagnosis of CAD presents challenges due to diverse clinical manifestations, from neck pain to severe neurological deficits.
Purpose of the Study:
- To review recent advancements in the diagnosis and treatment of cervical artery dissection (CAD) over the past five years.
- To highlight the evolving role of imaging and therapeutic strategies for CAD-related ischemic stroke.
Main Methods:
- Review of recent literature and studies published within the last five years.
- Analysis of diagnostic modalities, including the shift from invasive procedures to advanced MRI techniques.
- Evaluation of current therapeutic strategies, encompassing antiplatelet, anticoagulant, and endovascular treatments.
Main Results:
- Magnetic Resonance (MR) imaging sequences are increasingly replacing invasive diagnostic procedures like Digital Subtraction Angiography (DSA) due to their sensitivity and specificity for CAD.
- Current evidence suggests equivalent efficacy between antiplatelet and anticoagulant therapies for CAD patients, necessitating individualized treatment based on clinical features.
- NOACs are not yet recommended for CAD-related IS prevention due to a lack of randomized controlled trial evidence.
Conclusions:
- Endovascular therapies are a viable treatment option for CAD, particularly in cases of large vessel occlusion or failure of antithrombotic treatment.
- Further research is required to assess novel imaging techniques and therapeutic interventions for CAD.
- The management of CAD has evolved, emphasizing non-invasive diagnostics and tailored treatment approaches.
Abstract:
Cervical artery dissection (CAD) is a leading cause of ischaemic stroke (IS) in young and middle-aged adults. Despite well characterized clinical presentation, the diagnosis of CAD can be quite challenging due to a wide variety of symptoms ranging from minor neck pain to severe neurological symptoms. Invasive diagnostic procedures such as DSA are nowadays being replaced by the sensitive and CAD-specific sequences of MR. The most recent studies confirmed the overall efficacy of antiplatelet and anticoagulant therapies for CAD patients is equivalent, although patients should be qualified for concrete treatment on the basis of recently characterized clinical features. The use of NOAC in CAD-related IS prevention cannot yet be recommended due to the lack of evidences from randomized controlled trials. Endovascular therapies should be considered as the treatment of CAD, especially in the cases of large occlusion or antithrombotic treatment failure. Further research is needed to evaluate the efficacy of new imaging modalities and treatment options. This review summarize the last 5-year development of the diagnosis and treatment for CAD as a causative factor for IS.
