From the Research
The blood pressure goal for patients with vertebral artery dissection should be to maintain systolic blood pressure between 110-140 mmHg, as this range is typically recommended to minimize the risk of further dissection or rupture while ensuring adequate cerebral perfusion. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of careful blood pressure management in patients with vertebral artery dissection 1. Initial management often involves IV antihypertensive medications like labetalol (10-20 mg IV bolus, followed by 2-8 mg/min infusion) or nicardipine (5 mg/hr, titrated by 2.5 mg/hr every 5-15 minutes to a maximum of 15 mg/hr) in the acute setting. Once stabilized, oral antihypertensives such as amlodipine (5-10 mg daily), metoprolol (25-100 mg twice daily), or lisinopril (10-40 mg daily) can be used for maintenance therapy.
Some key points to consider in the management of vertebral artery dissection include:
- The importance of gradual blood pressure lowering to avoid hypoperfusion, which could worsen ischemic symptoms
- The need for antithrombotic therapy, typically aspirin 81-325 mg daily or anticoagulation with warfarin or a DOAC, to prevent thromboembolic complications
- The role of imaging studies, such as magnetic resonance with T1 fat-saturation (T1 FS) sequence of the cervical region or computed tomography (CT) with computed tomography angiography (CTA), in the diagnosis of cervical artery dissections
- The potential for vertebral artery dissection to cause ischemic stroke, subarachnoid hemorrhage, or other complications, and the need for careful monitoring and management to prevent these outcomes 2, 3.
Overall, the management of vertebral artery dissection requires a careful and nuanced approach, taking into account the individual patient's needs and the potential risks and benefits of different treatment strategies. By prioritizing blood pressure management and antithrombotic therapy, and carefully monitoring for potential complications, clinicians can help to minimize the risk of morbidity and mortality in patients with vertebral artery dissection.