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.

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