From the Guidelines
Treatment for vertebral artery dissection typically begins with anticoagulation therapy using either heparin followed by warfarin or antiplatelet medications like aspirin (81-325 mg daily) or clopidogrel (75 mg daily) for 3-6 months to prevent blood clots and stroke. The choice between anticoagulation and antiplatelet therapy depends on the patient's specific situation, with similar effectiveness reported for both approaches 1. For patients with severe symptoms or those who don't respond to medical management, endovascular treatments such as stenting may be necessary 1.
Key Considerations
- Complete bed rest is initially recommended, with gradual activity increase as symptoms improve.
- Pain management often includes analgesics like acetaminophen or NSAIDs.
- Most vertebral dissections heal naturally within 3-6 months with appropriate treatment.
- Regular follow-up imaging (typically MRA or CTA) is essential to monitor healing progress.
- Patients should avoid activities that involve extreme neck movements or trauma during recovery.
Treatment Goals
- The goal of treatment is to prevent stroke by maintaining adequate blood flow while the artery heals naturally, as most dissections resolve spontaneously with proper management.
- Antithrombotic treatment with either an anticoagulant or a platelet inhibitor for at least 3 to 6 months is reasonable for patients with extracranial carotid or vertebral arterial dissection associated with ischemic stroke or TIA 1.
Additional Recommendations
- For patients with stroke or TIA and extracranial carotid or vertebral arterial dissection who have definite recurrent cerebral ischemic events despite optimal medical therapy, endovascular therapy (stenting) may be considered 1.
- Patients with stroke or TIA and extracranial carotid or vertebral arterial dissection who fail or are not candidates for endovascular therapy may be considered for surgical treatment 1.
From the Research
Vertebral Dissection Treatment Overview
- Vertebral dissection is a condition where there is a tear in the wall of the vertebral artery, which can lead to stroke or other neurological symptoms.
- Treatment options for vertebral dissection include antiplatelet therapy and anticoagulation therapy.
Comparison of Antiplatelet and Anticoagulation Therapy
- A study published in Neurosurgery in 2017 2 compared antithrombotic treatments in patients with carotid and vertebral artery dissections and found that the rate of new or recurrent events is similar with antiplatelet and anticoagulation treatment.
- Another study published in Neurology India in 2019 3 found that the risk of recurrent ischemic events in carotid and vertebral artery dissection is low and is irrespective of the type of antithrombotic treatment.
- A randomized clinical trial published in JAMA Neurology in 2019 4 found that there was no significant difference between antiplatelet therapy and anticoagulation therapy in preventing stroke in cervical dissection.
Predictors of Outcome
- A study published in Neurology India in 2019 3 found that stroke as the presenting event and severity of stroke at onset were significant predictors of a poor three-month outcome.
- Another study published in European Journal of Neurology in 2013 5 found that a good functional outcome was observed in 82 patients, and the treatment used did not influence the functional outcome or recanalization.
Treatment Guidelines
- The Cervical Artery Dissection in Stroke Study (CADISS) 6, 4 is a prospective multicentre randomized-controlled trial that aimed to compare antiplatelet therapy and anticoagulation therapy in acute carotid and vertebral artery dissection.
- The study found that the recurrent stroke rate at 1 year was low, and there was no difference between treatment groups for any outcome.