Internal carotid and vertebral artery dissection: an approach to patient management

We aimed to evaluate the treatment results in patients with internal carotid artery (ICA) and vertebral artery (VA) dissection.

Materials and methods. We examined 285 patients (122 men and 163 women, mean age 37.7 ± 8.1 years) with ICA dissection (n = 147), VA dissection (n = 122), or a combination of both (n = 16). The dissection presented as ischemic stroke in 175 patients and with local symptoms in the others. Out of 173 patients, 156 were managed conservatively. Efficacy of the conservative treatment in first 3 months was assessed in 143 patients who received anticoagulants (AC; n = 38), antiplatelets (AP; n = 42), both (n = 45) or no antithrombotic therapy (n = 18).

Results. Good functional recovery (0–2 points on the modified Rankin Scale) after 3 months was noted in 70% of patients, with no statistically significant differences between the different treatment types. There were 3 (2%) deaths in patients with severe stroke receiving AC. Recurrent ischemic stroke occurred in 10% of patients most often (86%) occurring in the first 3 weeks and triggered by head movement, straining, or fluctuating blood pressure. No statistically significant differences were found between different conservative treatments. However, there was a tendency towards increased frequency of recurrent stroke in patients without antithrombotic therapy (22%), as compared with patients receiving AC (4%) or AP (12%). There were no strokes in 110 patients with local symptoms due to ICA/VA dissection during the observation period.

Conclusion. There were no statistically significant differences in AC and AP efficacy in patients with ICA or VA dissection. A neck brace to prevent head movement and control of blood pressure are advisable alongside pharmacological therapy.