Treatment of Acute Ischemic Stroke Attributable to Cervical Vertebral Artery Dissection

Cervical vertebral artery dissection can directly cause acute ischemic stroke, creating a time-sensitive clinical scenario in which acute treatment eligibility must be rapidly assessed.

Clinical Scenario

This protocol applies to patients presenting with acute ischemic stroke attributable to cervical (vertebral) artery dissection — a specific setting in which acute treatment strategies are considered when the patient meets established eligibility criteria.

Treatment Goals

The primary clinical target is a favorable functional outcome, defined as a modified Rankin Scale score of 0–2 at 90 days.

Approach Overview

For otherwise eligible patients with a large-vessel occlusion in this setting, a mechanical intervention is among the acute treatment strategies considered — the full protocol specifies the complete eligibility framework, decision criteria, and sequencing.

Instant Access to Structured Evidence-Based Regimens

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.

It is reasonable to perform mechanical thrombectomy in otherwise eligible patients with a large-vessel occlusion in the setting of cervical artery dissection.

The need for emergent mechanical thrombectomy in patients with cervical artery dissection is based on existing criteria for thrombectomy in patients with acute large-vessel occlusion.

A meta-analysis comparing patients with cervical artery dissection and concurrent acute ischemic stroke found that mechanical thrombectomy increased favorable functional outcomes (modified Rankin Scale score, 0–2 at 90 days) compared with medical management (62.9% versus 41.5%; P=0.006), with no difference in symptomatic ICH or mortality.

View source ↗