Carotid Dissection: Pathophysiology and Treatment

Cervical artery dissection is one of the leading causes of ischemic stroke in young adults, and poses unique diagnostic and therapeutic challenges due to an often nonspecific clinical presentation. Prompt recognition is essential, as early ischemic events are common within the first 2 to 4 weeks. This review summarizes current evidence on the epidemiology, pathophysiology, clinical features, diagnostic strategies, and management of cervical carotid artery dissections. While antithrombotic therapy is the mainstay of secondary stroke prevention, the optimal choice between antiplatelet and anticoagulation remains uncertain. Randomized trials and large cohort studies suggest similar efficacy between antiplatelet and anticoagulant therapies, though anticoagulation may confer benefit in patients with vessel occlusion. Recurrent dissection and ischemic events are rare, and dissecting aneurysms generally have a benign course. Endovascular intervention is reserved for select cases. A tailored, risk-based approach to therapy-guided by clinical and radiographic features-is essential to improve outcomes in this complex and heterogeneous population.