This protocol addresses cervical artery dissection where the patient presents with low bleeding risk and an absence of high-risk radiological features — specifically, no intraluminal thrombus and a nonocclusive dissection pattern.
Patients without radiographic high-risk features represent a distinct sub-population in cervical artery dissection. The absence of intraluminal thrombus and a nonocclusive dissection pattern — alongside low extracranial or intracranial hemorrhage risk — directly shape the choice of antithrombotic strategy. Identifying this profile is the critical first step before selecting a regimen.
For this profile, current evidence supports an antiplatelet-based antithrombotic strategy. The regimen involves more than one phase — the full protocol specifies the sequencing and duration appropriate for this scenario.
DOI: 10.1161/STR.0000000000000457
Patients without radiographic high-risk features or those with an elevated risk of extracranial hemorrhage or ICH (eg, large infarct size, hemorrhagic transformation, intradural extension of extracranial dissection) may be better suited for antiplatelet therapy, with either antiplatelet monotherapy or a short course of dual antiplatelet therapy for 21 to 90 days (in line with minor stroke/TIA and CADISS) if considered safe, followed by single antiplatelet therapy.
Although the evidence for use in cervical artery dissection is weak, a short course of dual antiplatelet therapy with a loading dose (followed by single antiplatelet agent) might be preferred over monotherapy when deemed safe, particularly in patients who would have qualified for the dual antiplatelet trials for early prevention after minor stroke/TIA.
It is reasonable that the duration of antithrombotic therapy in patients with cervical artery dissection be 3–6 mo.
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