Abstract:-Extra-cranial arterial dissection accounts for 10% of strokes in young people. Information on safety of thrombolytic administration in this group is limited. The literature, however, does not favor use of thrombolytics for myocardial ischemia when peripheral arterial dissection coexists. Based on the clinical and radiological features, two patients who presented with acute stroke secondary to arterial dissection were considered for thrombolysis. One of them received intra-venous recombinant tissue plasminogen… Show more
“…In spite of providing insufficient data for assessment of efficacy, four non-randomised studies of intravenous thrombolysis showed that complication rates were no greater than thrombolysis for other ischemic stroke etiologies, suggesting that this treatment should not be withheld in patients with suspected SCAD [48][49][50][51] . regarding intra-arterial thrombolysis (IAT), few case reports have been published and showed no rupture of the dissected vessel, intracranial or subarachnoid hemorrhage or peri-interventional arterial embolism 52,53 . Surgery or endovascular procedures have been described in patients with persistent or progressive symptoms despite adequate clinical therapy, in those with hemodynamically significant residual stenosis, or in the presence of contraindications to anticoagulant therapy 31,54 .…”
-Spontaneous cervical arterial dissection (SCAD) is a non-traumatic tear or disruption in the wall of the internal carotid arteries or the vertebral arteries. It accounts for about 25% of strokes in patients aged under 45 years. Awareness of its clinical features and advances in imaging over the last two decades have contributed to earlier identification of this condition. SCAD has become the commonest form of vascular lesion identified in the cervical carotid and vertebral arteries, second only to atherosclerosis. This review is an update on the epidemiology, vulnerable arterial segments, risk factors, clinical features, diagnosis, current treatment and prognosis of SCAD.Key worDS: dissection, carotid, vertebral artery, stroke, angiography.
Dissecção espontânea da artéria cervical: atualização sobre aspectos clínicos e diagnósticosResumo -Dissecção arterial cervical espontânea (DACe) é uma laceração ou ruptura na parede de artérias cervicais responsáveis pela irrigação sanguínea cerebral: artérias carótidas internas e artérias vertebrais. É responsável por cerca de 25% dos acidentes vasculares cerebrais isquêmicos em pacientes abaixo de 45 anos de idade. Ao longo das duas últimas décadas, com a maior conscientização sobre suas manifestações clínicas e o avanço das técnicas de neuroimagem, a DACe tem sido diagnosticada mais precocemente, tornando-se o tipo de lesão vascular mais comumente identificado nas artérias cervicais, sendo superada apenas pelas lesões ateroscleróticas. esta revisão é uma atualização sobre a epidemiologia, segmentos arteriais mais vulneráveis, fatores de risco, manifestações clínicas, diagnóstico, tratamento e prognóstico da DACe.PAlAvrAS-ChAve: dissecção, artéria vertebral, acidente vascular cerebral, arteriografia.
“…In spite of providing insufficient data for assessment of efficacy, four non-randomised studies of intravenous thrombolysis showed that complication rates were no greater than thrombolysis for other ischemic stroke etiologies, suggesting that this treatment should not be withheld in patients with suspected SCAD [48][49][50][51] . regarding intra-arterial thrombolysis (IAT), few case reports have been published and showed no rupture of the dissected vessel, intracranial or subarachnoid hemorrhage or peri-interventional arterial embolism 52,53 . Surgery or endovascular procedures have been described in patients with persistent or progressive symptoms despite adequate clinical therapy, in those with hemodynamically significant residual stenosis, or in the presence of contraindications to anticoagulant therapy 31,54 .…”
-Spontaneous cervical arterial dissection (SCAD) is a non-traumatic tear or disruption in the wall of the internal carotid arteries or the vertebral arteries. It accounts for about 25% of strokes in patients aged under 45 years. Awareness of its clinical features and advances in imaging over the last two decades have contributed to earlier identification of this condition. SCAD has become the commonest form of vascular lesion identified in the cervical carotid and vertebral arteries, second only to atherosclerosis. This review is an update on the epidemiology, vulnerable arterial segments, risk factors, clinical features, diagnosis, current treatment and prognosis of SCAD.Key worDS: dissection, carotid, vertebral artery, stroke, angiography.
Dissecção espontânea da artéria cervical: atualização sobre aspectos clínicos e diagnósticosResumo -Dissecção arterial cervical espontânea (DACe) é uma laceração ou ruptura na parede de artérias cervicais responsáveis pela irrigação sanguínea cerebral: artérias carótidas internas e artérias vertebrais. É responsável por cerca de 25% dos acidentes vasculares cerebrais isquêmicos em pacientes abaixo de 45 anos de idade. Ao longo das duas últimas décadas, com a maior conscientização sobre suas manifestações clínicas e o avanço das técnicas de neuroimagem, a DACe tem sido diagnosticada mais precocemente, tornando-se o tipo de lesão vascular mais comumente identificado nas artérias cervicais, sendo superada apenas pelas lesões ateroscleróticas. esta revisão é uma atualização sobre a epidemiologia, segmentos arteriais mais vulneráveis, fatores de risco, manifestações clínicas, diagnóstico, tratamento e prognóstico da DACe.PAlAvrAS-ChAve: dissecção, artéria vertebral, acidente vascular cerebral, arteriografia.
“…In 6 patients with sICAD who underwent IAT, no rupture of the dissected vessel, cervical, subarachnoid or intracranial hemorrhage, or periinterventional (Furlan et al 1999) arterial embolism was described (Abboud et al 2005;Arnold et al 2002;Sampognaro et al 1999;Zaidat et al 2001). Nedeltchev et al (Nedeltchev et al 2005) reported a patient with sICAD causing symptomatic occlusion of the middle cerebral artery who underwent MT without adverse events.…”
Section: Intraarterial and Mechanical Thrombolysismentioning
This manuscript reviews the management of patients with spontaneous dissection of the cervical internal carotid artery (sICAD). Recommendations are not based on controlled-randomized trials, but on case-control and observational, hospital-based studies, and case reports. Vascular risk factors seem to be as prevalent in patients with sICAD as in age-matched, healthy volunteers. Stroke prevention includes the treatment of vascular risk factors and the administration of oral aspirin, which may be as effective as anticoagulation. The few available data indicate that most patients with sICAD causing severe stenosis or occlusion, or an aneurysm can be treated conservatively. Patients with sICAD were not excluded in the intravenous controlled-randomized thrombolysis trials with tissue plasminogen activator, but were excluded in the intraarterial controlled-randomized thrombolysis trials. Taking the few published case series and reports on thrombolysis in patients with sICAD into consideration, intravenous thrombolysis may be beneficial, whereas it remains unclear whether intraarterial thrombolysis is useful. This manuscript reviews the management of patients with spontaneous dissection of the cervical internal carotid artery (sICAD). The first part will deal with stroke prevention, in particular the vascular risk factors, antithrombotic therapy, and the treatment of severe stenosis or occlusion, and dissecting aneurysm. The second part will discuss thrombolytic treatment of acute ischemic stroke due to sICAD.
Management of Spontaneous Dissection of the Cervical Carotid Artery
“…Small case series and case reports have documented the successful treatment of ischemic stroke associated with cervicocranial artery dissection with intravenous and intra-arterial thrombolysis [77][78][79][80][81]. Others advocate the use of endovascular or surgical therapy for stroke prevention in selected patients with persistent severe stenosis or occlusion after internal carotid artery dissection and recurrent cerebral ischemic symptoms despite medical therapy.…”
There are a large variety of non-atherosclerotic causes of ischemic stroke in the young. Arterial dissection, most commonly associated with non-traumatic causes, is among the most common. Both the carotid and vertebrobasilar circulations can be affected. The vasculitidies represent a rare, but potentially treatable series of conditions that can lead to stroke through diverse mechanisms. Moyamoya is a nonatherosclerotic, noninflammatory, nonamyloid vasculopathy characterized by chronic progressive stenosis or occlusion of the distal internal carotid arteries and/or proximal portions of the middle and/or anterior cerebral arteries. Moyamoya can be idiopathic (moyamoya disease) or the result of other conditions. An appreciation of the unusual causes of stroke in the young is important when considering secondary prevention measures.
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