Patients With Cervical Artery Dissection

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Cervical Artery Dissection

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease (DO NOT EDIT)

Recommendations for Management of Patients With Cervical Artery Dissection

Class I

"1.Contrast-enhanced CTA, MRA, and catheter-based contrast angiography are useful for diagnosis of cervical artery dissection. (Level of Evidence: C)"

Class IIa

"1.For patients with symptomatic cervical artery dissection, anticoagulation with intravenous heparin (dose-adjusted to prolong the partial thromboplastin time to 1.5 to 2.0 times the control value) followed by warfarin (dose-adjusted to achieve a target INR of 2.5 [range 2.0 to 3.0]), low-molecular-weight heparin (in the dose recommended for treatment of venous thromboembolism with the selected agent) followed by warfarin (dose-adjusted to achieve a target INR of 2.5 [range 2.0 to 3.0]), or oral anticoagulation without antecedent heparin can be beneficial for 3 to 6 months, followed by antiplatelet therapy with aspirin (81 to 325 mg daily) or clopidogrel (75 mg daily). (Level of Evidence: C) "

Class IIb

"1.Carotid angioplasty and stenting might be considered when ischemic neurological symptoms have not responded to antithrombotic therapy after acute carotid dissection. (Level of Evidence: C) "

"2.The safety and effectiveness of pharmacological therapy with a beta-adrenergic antagonist, angiotensin inhibitor, or nondihydropyridine calcium channel antagonist (verapamil or diltiazem) to lower blood pressure to the normal range and reduce arterial wall stress are not well established (Level of Evidence: C) "

References

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