Top Things to Know: Treatment and Outcomes of Cervical Artery Dissection in Adults

Published: February 01, 2024

Prepared by Anne Leonard MPH, BSN, RN, FAHA, National Senior Director Science and Medicine

Cervical artery dissection (CAD) contributes to 2% of all ischemic strokes but up to 25% of ischemic stroke in adults under 50 years of age.
CAD can occur in the absence of major trauma to the neck and is usually due to an intimal tear or rupture of the vasa vasorum. This can lead to an intraluminal thrombus, vascular stenosis, occlusion, or dissection aneurysm formation.
CAD can present with neck pain, cranial nerve compression or cerebral or? spinal cord ischemia, headache, dizziness, or tinnitus.
Symptoms are often non-specific, making CAD diagnosis challenging. This statement provides considerations for evaluation of symptoms specific to CAD.
Diagnostic modalities for CAD include Magnetic Resonance Imaging (MRI)/ Magnetic Resonance Angiography (MR), Computed Tomographic Angiography (CTA), ultrasound and conventional digital subtraction angiography (DSA).
Other potential causes of CAD include connective tissue disorders (and maybe genetic testing depending on presentation) and might be considered in the differential diagnosis.
The timing of ischemic stroke in persons with CAD has ranged from a few minutes to 31 days, with most patients (82%) experiencing ischemic stroke in the first week after symptom onset.
Hyperacute treatments include intravenous thrombolysis with either alteplase or tenecteplase, mechanical thrombectomy, and acute cervical artery stenting.
Secondary prevention modalities of CAD are discussed highlighting individualized anti-thrombotic therapy as well as information regarding risk predictors for recurrent dissection.
This scientific statement provides the clinician with information on the diagnosis, treatment, and long-term management of CAD.

View the summary for Treatment and Outcomes of Cervical Artery Dissection in Adults

Citation

Yaghi S, Engelter S, Del Brutto VJ, Field TS, Jadhav AP, Kicielinski K, Madsen TE, Mistry EA, Salehi Omran S, Pandey A, Raz E; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Peripheral Vascular Disease. Treatment and outcomes of cervical artery dissection in adults: ascientific statement from the American Heart Association. Stroke. Published online February 1, 2024. doi: 10.1161/STR.0000000000000457