International survey on the management of cervical artery dissection: assessing consensus and variability in practice

Cervical artery dissection (CAD) is a leading cause of stroke in young adults, accounting for up to 25% of strokes in this population. Despite its prevalence, management strategies vary widely due to limited large-scale randomized trials and inconsistent findings in the literature. This study aims to assess treatment practices for CAD and evaluate the consistency of clinical decision-making among stroke physicians using a structured survey. An international survey was distributed to stroke physicians and trainees, including participants in the STOP-CAD and TREAT-CAD studies. The survey explored patient characteristics influencing treatment decisions, preferred antithrombotics, treatment duration, and criteria for stopping therapy. Six case-based scenarios assessed initial treatment choices, follow-up imaging practices, and medication duration. Responses were analyzed using Krippendorff's alpha to quantify inter-rater reliability and evaluate consensus among respondents. The survey was completed by 102 stroke physicians and trainees, revealing moderate agreement, with a Krippendorff's alpha of 0.481. Significant variability was observed in CAD management, particularly in the choice of antithrombotic treatment and treatment duration. However, strong consensus was found regarding the use of follow-up imaging (99.16%), with computed tomography angiography (CTA) being the preferred modality (63.2%). The variability in CAD management highlights the need for further research to establish standardized, evidence-based guidelines.