How is cervical artery dissection treated?
In some cases, cervical artery dissection is not diagnosed until after a stroke has developed. In those patients, treating stroke to prevent lasting effects is the goal.
When a patient comes into the doctor's office or the emergency room with symptoms of cervical artery dissection without stroke, preventing stroke is the primary treatment goal. Appropriate treatment for an individual patient depends on whether the patient has an underlying disorder such as fibromuscular dysplasia or vascular Ehlers-Danlos or Marfan syndrome or has experienced trauma, where and how the injury occurred and if the patient has other injuries or medical conditions.
First-line treatment for cervical artery dissection usually is antiplatelet agents (such as aspirin) or anti-coagulation to prevent the formation of blood clots. Antiplatelet drugs such as aspirin or clopidogrel may used alone or in combination. Alternatively, heparin given intravenously (through the vein) or an injectable (shot) form followed by warfarin can also be used. These medications prevent blood clot formation and thus can help protect against stroke. There is no definite evidence yet that one class of drugs is better than the other for preventing clot formation in patients with carotid or vertebral artery dissection. They usually are prescribed for three to six months, but some patients may require longer treatment.
Those patients who are unable to take either anticoagulants or antiplatelet agents, or those who continue to have symptoms (such as vision disturbances or weakness) despite good blood thinners, or those who have very low blood flow to the brain due to dissection may need a procedure to try and correct the process of dissection. Normally, these are minimally invasive treatments that are performed through the blood vessels. Angioplasty (repairing the dissected section of artery with inflation of a special balloon) or placement of a stent (a mesh-like device that holds the artery open) are two endovascular procedures that are used to treat cervical artery dissections. They frequently are used together to provide the longest-lasting treatment. Cleveland Clinic interventional cardiologists, neurointerventionalists, and vascular surgeons perform over 200 endovascular procedures every year on patients with carotid artery disease.
What is the outlook following cervical artery dissection?
For spontaneous cervical artery dissection, the mortality is less than 5 percent. The risk for lasting neurological impairment from the disease is considerably higher. More than half of patients with spontaneous cervical artery dissection develop a stroke, sometimes delayed by hours or days. Even so, an estimated 75 percent of patients with spontaneous cervical artery dissection make a good recovery.
Following the first incidence of cervical artery dissection, patients have a 1 percent risk of recurrence per year over the next 10 years. Risk of recurrence is higher in the first few weeks after the initial event and in younger patients than older patients, but younger patients also respond better to treatment and have a better outlook. Some patients have reported persistent headache after cervical artery dissection, lasting years after the event.
People who have had cervical artery dissection should see a vascular or neurology specialist for a CTA, MRA or other imaging to assess the severity and extension of the dissection. This imaging is normally repeated several months later to have the dissection re-evaluated for either progression, resolution or stability of the injury.
Your doctor may recommend that you modify some of your activities, such as your exercise program, to avoid activities that may increase the risk of future events (such as heavy lifting). Patients who have had a cervical artery dissection may need to be checked for vascular disease in other parts of the body.
How can I prevent cervical artery dissection?
If you have an underlying disease that increases your risk of cervical artery dissection, such as fibromuscular dysplasia or vascular Ehlers-Danlos syndrome, it is important that you are under the care of a vascular specialist and follow your doctor’s instructions. For other individuals, following the same steps that reduce your risk of heart disease – healthy eating, blood pressure control, weight management, exercise and smoking cessation – can reduce your risk of cervical artery dissection by improving the health of your blood vessels.