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Current Cardiology Reports
Published in: Current Cardiology Reports 12/2021

01-12-2021 | Stroke | Stroke (DL Tirschwell, Section Editor)

Stroke Prevention in Cervical Artery Dissection

Authors: Rick Gill, José Biller

Published in: Current Cardiology Reports | Issue 12/2021

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Abstract

Purpose of Review

Cervical artery dissection (CAD) is rare, yet it is a common cause of stroke in young and middle-aged adults. Historically, some senior clinicians favored anticoagulation in the prevention of stroke due to CAD. Choosing the optimal antithrombotic treatment with either antiplatelet (AP) or anticoagulant (AC) medications remains a challenge. This paper will review the clinical features and imaging of CAD, and the acute treatment and prevention of stroke due to CAD.

Recent Findings

Until 2015, there were no prospective randomized trials in the optimal antithrombotic management of CAD. The Cervical Artery Dissection in Stroke Study (CADISS) trial found that treatment with AC did not lower the risk of subsequent stroke or death at 3 months when compared to AP agents. This led to a paradigm shift in national guidelines. In 2021, The Biomarkers and Antithrombotic Treatment in of Cervical Artery Dissection (TREAT-CAD) trial however did not confirm the non-inferiority of AP therapy in stroke prevention due to CAD.

Summary

The optimal antithrombotic management for stroke prevention in CAD remains uncertain, while the superiority of anticoagulation has not been established, nor has the non-inferiority of AP agents. The future direction of research should consider early preventative treatment, dual treatment with AP agents, direct oral AC medications, and aggregation of data from existing randomized trials.
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Metadata
Title
Stroke Prevention in Cervical Artery Dissection
Authors
Rick Gill
José Biller
Publication date
01-12-2021
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 12/2021
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-021-01603-2

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