This protocol addresses a specific subset of cervical artery dissection: patients who carry high-risk radiological features on imaging and a low overall risk of bleeding. The combination of these factors shapes the management strategy.
Cervical artery dissection presenting with one or more high-risk radiological features — including intraluminal thrombus, severe stenosis, or occlusive dissection — in a patient with a low risk of bleeding. These radiographic findings are recognised predictors of ischemic stroke following dissection, which is the basis for a more active interventional approach in this population.
Management in this setting may involve a targeted endovascular intervention directed at the dissected vessel. In selected patients where that primary approach is not feasible, an alternative strategy involving the affected vessel may be considered depending on collateral circulation status. The full structured regimen — including patient selection criteria, sequencing, and decision points — is available via the link below.
DOI: 10.1161/STR.0000000000000457
The presence of radiographic high-risk features that are known predictors of ischemic stroke after dissection (such as severe stenosis or occlusion, intraluminal thrombus) in patients with low risk of bleeding may warrant anticoagulation therapy.
Angioplasty and stenting may be fairly safe and beneficial in a limited population of patients with flow-limiting stenosis who fail medical treatment.
When angioplasty and stenting are not feasible, vessel sacrifice may be considered in patients with recurrent ischemic stroke but adequate compensatory circulation.
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