Management of Cervico-Cranial Arterial Dissections
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Women’ Cerebrovascular Disease and Stroke (S Silverman, Section Editor)
Management of Cervico-Cranial Arterial Dissections Ashby Clay Turner, MD1,2,3,* Erica Camargo Faye, MD, MMSc, PhD2,3 Address *,1 Massachusetts General Hospital, 55 Fruit Street, Suite 835, Boston, MA, 02114, USA Email: [email protected] 2 Harvard Medical School, Boston, MA, USA 3 Department of Neurology, Massachusetts General Hospital, 175 Cambridge St. Suite 340, Boston, MA, 02114, USA
Published online: 13 November 2020 * Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Cerebrovascular Disease and Stroke Keywords Cervical artery dissection I Intracranial artery dissection I Management acute ischemic stroke
Abstract Purpose of review Cervico-cranial arterial dissections are a distinct etiology of both ischemic and hemorrhagic neurovascular events. These dissections can involve the extracranial carotid or vertebral arteries, classified collectively as cervical artery dissections, or can be intracranial arterial dissections, and complications and management of each differ. The most recent evidence is reviewed in this publication. Recent findings Significant heterogeneity regarding treatments of dissections exists among providers and with recent advances in endovascular approaches to neurovascular care, appreciating the latest evidence on the guidance of treatment has never been so challenging. Furthermore, recognizing the complications of cervico-cranial dissections and implementing appropriate therapies can have a significant impact on patient outcomes. Summary Overall, limited randomized controlled data exists regarding the treatment of cervico-cranial dissections. Approach to management of these dissections and potential complications is largely based on observational studies and reported cases. The available evidence and strength vary depending on the case and complication.
Introduction Cervico-cranial arterial dissections, recognized by the presence of a hematoma within the arterial wall, are a
distinct etiology of neurovascular events, including acute ischemic stroke (AIS) and transient ischemic attack
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(TIA), as well as subarachnoid hemorrhage (SAH) [1]. Dissections are categorized as (a) spontaneous, including those not preceded by a clear traumatic event, or (b) traumatic, in which an inciting event is appreciated [2]. In much of the dissection literature, particularly the larger trials, both etiologies are included. It is estimated that up to 2% of all strokes are due to arterial dissection, but rates are higher in young patients [3, 4]. Arterial dissections leading to such neurovascular events can involve the extracranial carotid or vertebral arteries, classified collectively as cervical artery dissections (CAD), or can be intracranial artery dissections (IAD), and complications and management of each can differ. Either the vertebral arteries, carotid arteries, or intracranial arteries can be
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