Treatment Options and Outcomes of Cervical Artery Dissection in Adults: Eytan Raz, MD, PhD

WATCH TIME: 7 minutes

"Now that there is [blood] flow, there’s a flap, there’s a dissection. What am I going to do? Do I stent it? Should I stent it now? Or should we hold off? Because the problem in this setting is that if you have to put the patient on antiplatelets acutely—these are patients who just had a stroke, so you don’t know how much infarct is in the brain—you run a risk. That’s always a dilemma, and that’s patient by patient."

Cervical artery dissection contributes 2% of all ischemic strokes but up to 25% of ischemic stroke in adults younger than 50 years of age. The pathogenesis of cervical artery dissection is multifactorial and involves the interplay of comorbidities, environmental triggers, genetic or congenital factors, including connective tissue disorders, and anatomic factors such as elongated styloid process or increased vascular tortuosity. Patients will often present with a variety of symptoms, including headache, neck pain, dizziness, and tinnitus, which further add to the challenges of diagnosing cervical artery dissection.

Recently, the American Heart Association published a scientific statement overviewing the available evidence of cervical artery dissection while providing suggestions on the diagnostic evaluation, treatment approaches, and outcomes. Using data from 1990 to 2022, the authors concluded that acute treatment strategies such as thrombolysis and mechanical thrombectomy are reasonable in otherwise eligible patients. Additionally, they suggested that the antithrombotic therapy choice should be individualized and continued for at least 3 to 6 months. Furthermore, the study investigators provided thoughts on lifestyle modifications to avoid recurrent/worsening dissection, as well as background on follow-up imaging and recanalization of the dissection.

Shortly after the publication of the review, NeurologyLive^® sat down with study author Eytan Raz, MD, PhD, a neurointerventional radiologist at NYU Langone, to get his thoughts on the major clinical takeaways. Raz, who also serves as an associate professor at NYU Grossman School of Medicine, gave clarity on the use of stenting in acute settings and the factors that go into the timing and optimal candidate for such approach. He also discussed the risk of putting certain patients on antiplatelets and when closing off vertebral arteries to prevent further embolism should be considered.

REFERENCE
1. Yaghi S, Engelter S, Del Brutto VJ, et al. Treatment and outcomes of cervical artery dissection in adults; a scientific statement from the American Heart Association. STROKE. 2024;55(3):e91-e106. doi:10.1161/STR.0000000000000457