Treatment of Vertebral Artery Dissection Presenting as Acute Ischemic Stroke
When cervical vertebral artery dissection is the identified cause of acute ischemic stroke, clinicians must determine whether standard acute reperfusion strategies apply — and the evidence indicates they do in eligible patients.
Clinical Scenario
Acute ischemic stroke attributable to cervical (vertebral) artery dissection. The central management question is whether standard acute treatment strategies — including thrombolysis — remain applicable in this aetiology.
Treatment Approach (Partial Overview)
For otherwise eligible patients, the approach involves intravenous thrombolytic therapy applied according to standard acute ischemic stroke criteria. Complete eligibility requirements, specific agent selection, and the full structured regimen are detailed in the protocol below.
References
DOI: 10.1161/STR.0000000000000457
- In patients with acute ischemic stroke attributable to cervical artery dissection, acute treatment strategies such as thrombolysis and mechanical thrombectomy are reasonable in otherwise eligible patients.
- Intravenous thrombolysis (IVT), with either alteplase or tenecteplase, is a highly efficacious acute ischemic stroke treatment and leads to improved functional outcome.
- In the absence of data suggesting safety concerns and given the proven efficacy of IVT in otherwise eligible patients with acute ischemic stroke, it is reasonable to consider IVT for patients with acute ischemic stroke with cervical artery dissection if they meet other standard criteria, as recommended by current guidelines.
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