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Stroke Prevention in Cervical Artery Dissection
1Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, 560153, USA. rick.gill@lumc.edu.
Insights
Optimal antithrombotic treatment for cervical artery dissection (CAD) remains uncertain. While anticoagulation did not prove superior to antiplatelet agents in preventing stroke, antiplatelet therapy
Area of Science:
- Neurology
- Vascular Medicine
- Cardiology
Background:
- Cervical artery dissection (CAD) is a significant cause of stroke in younger adults.
- Antithrombotic treatment choice for CAD, either antiplatelet (AP) or anticoagulant (AC), is challenging.
- Historical practices favored AC, but evidence remains debated.
Purpose of the Study:
- To review clinical features and imaging of CAD.
- To discuss acute treatment and stroke prevention strategies for CAD.
- To evaluate current antithrombotic management options for CAD.
Main Methods:
- Review of clinical features and imaging in CAD.
- Analysis of findings from major randomized trials (CADISS, TREAT-CAD).
- Discussion of current and future antithrombotic treatment strategies.
Main Results:
- The CADISS trial showed AC was not superior to AP agents for stroke prevention at 3 months.
- The TREAT-CAD trial did not confirm the non-inferiority of AP therapy.
- Optimal antithrombotic management for CAD stroke prevention remains uncertain.
Conclusions:
- Neither AC nor AP therapy has definitively proven superior for stroke prevention in CAD.
- Further research is needed, potentially exploring dual AP therapy or novel oral anticoagulants.
- Aggregating data from existing trials may clarify optimal treatment pathways.
Purpose Of Review:
Cervical artery dissection (CAD) is rare, yet it is a common cause of stroke in young and middle-aged adults. Historically, some senior clinicians favored anticoagulation in the prevention of stroke due to CAD. Choosing the optimal antithrombotic treatment with either antiplatelet (AP) or anticoagulant (AC) medications remains a challenge. This paper will review the clinical features and imaging of CAD, and the acute treatment and prevention of stroke due to CAD.
Recent Findings:
Until 2015, there were no prospective randomized trials in the optimal antithrombotic management of CAD. The Cervical Artery Dissection in Stroke Study (CADISS) trial found that treatment with AC did not lower the risk of subsequent stroke or death at 3 months when compared to AP agents. This led to a paradigm shift in national guidelines. In 2021, The Biomarkers and Antithrombotic Treatment in of Cervical Artery Dissection (TREAT-CAD) trial however did not confirm the non-inferiority of AP therapy in stroke prevention due to CAD. The optimal antithrombotic management for stroke prevention in CAD remains uncertain, while the superiority of anticoagulation has not been established, nor has the non-inferiority of AP agents. The future direction of research should consider early preventative treatment, dual treatment with AP agents, direct oral AC medications, and aggregation of data from existing randomized trials.
