Stroke Prevention in Cervical Artery Dissection

Gill, Rick; Biller, José

doi:10.1007/s11886-021-01603-2

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…Although there is no clear consensus on an antithrombotic treatment regimen for stroke prevention in CeAD, the opinion of our group, as well as certain experts in the field, 91 favors anticoagulation then transitioning to antiplatelet therapy after stable imaging and clinical course. 92 This is identified as a knowledge gap in the current guidelines.…”

Section: Immediate Complicationsmentioning

confidence: 93%

Cervical Artery Dissections: Etiopathogenesis and Management

Keser¹,

Chiang²,

Benson³

et al. 2022

VHRM

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Cervical Artery Dissection (CeAD) is a frequent stroke etiology for patients younger than 50 years old. The most common immediate complications related to CeAD are headache and neck pain (65–95%), TIA/ischemic stroke (>50%), and partial Horner’s syndrome (25%). The prevailing hypothesis regarding the pathogenesis of sCeAD is that the underlying constitutional vessel wall weakness of patients with sCeAD is genetically determined and that environmental factors could act as triggers. The stroke prevention treatment of CeAD remains controversial, involving anticoagulation or antiplatelet therapy and potentially emergent stenting and/or thrombectomy or angioplasty for selected cases of carotid artery dissection with occlusion. The treatment of headache associated with CeAD depends on the headache phenotype and comorbidities. Radiographically, more than 75% of CeAD cases present with occlusion or non-occlusive stenosis. Many patients demonstrate partial and complete healing, more commonly in the carotid arteries. One-fifth of the patients develop dissecting pseudoaneurysm, but this is a benign clinical entity with an extremely low rupture and stroke recurrence risk. Good recovery is achieved in many CeAD cases, and mortality remains low. Family history of CeAD, connective tissue disorders like Ehlers-Danlos syndrome type IV, and fibromuscular dysplasia are risk factors for recurrent CeAD, which can occur in 3–9% of the cases. This review serves as a comprehensive, updated overview of CeAD, emphasizing etiopathogenesis and management.

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Section: Immediate Complicationsmentioning

confidence: 93%

Cervical Artery Dissections: Etiopathogenesis and Management

Keser¹,

Chiang²,

Benson³

et al. 2022

VHRM

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“…When the stroke etiology is determined to be cardioembolic or due to a thrombophilia, anticoagulation is typically recommended [ 43 ]. In the case of cervical arterial dissection, there are no pediatric data to guide the choice of antithrombotic agent, and there remains equipoise in adults as well [ 227 , 228 ]. The presence of an intraluminal thrombus may prompt the clinician to opt for anticoagulation, while a large associated stroke may make antiplatelet therapy more appropriate.…”

Section: Therapeuticsmentioning

confidence: 99%

Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke

Sun

Lynch

2023

Neurotherapeutics

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Though rare, stroke in infants and children is an important cause of mortality and chronic morbidity in the pediatric population. Neuroimaging advances and implementation of pediatric stroke care protocols have led to the ability to rapidly diagnose stroke and in many cases determine the stroke etiology. Though data on efficacy of hyperacute therapies, such as intravenous thrombolysis and mechanical thrombectomy, in pediatric stroke are limited, feasibility and safety data are mounting and support careful consideration of these treatments for childhood stroke. Recent therapeutic advances allow for targeted stroke prevention efforts in high-risk conditions, such as moyamoya, sickle cell disease, cardiac disease, and genetic disorders. Despite these exciting advances, important knowledge gaps persist, including optimal dosing and type of thrombolytic agents, inclusion criteria for mechanical thrombectomy, the role of immunomodulatory therapies for focal cerebral arteriopathy, optimal long-term antithrombotic strategies, the role of patent foramen ovale closure in pediatric stroke, and optimal rehabilitation strategies after stroke of the developing brain. Supplementary Information The online version contains supplementary material available at 10.1007/s13311-023-01373-5.

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