This protocol addresses cervical artery dissection in patients where the radiological picture does not include high-risk features — no intraluminal thrombus is identified and the dissection is nonocclusive — alongside a moderate bleeding risk that informs the choice of antithrombotic strategy.
Cervical artery dissection with moderate bleeding risk, absence of intraluminal thrombus, and nonocclusive dissection. The absence of high-risk radiological features is the key determinant that shapes antithrombotic management in this population.
In this setting, an antiplatelet-based approach is favoured — the complete regimen, including agent selection, duration, and monitoring, is detailed in the full protocol.
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.
It is reasonable that the duration of antithrombotic therapy in patients with cervical artery dissection be 3–6 mo.