Treatment of Vertebral Artery Dissection with Low Bleeding Risk and No High-Risk Radiological Features
This protocol addresses vertebral artery dissection in patients whose bleeding risk is not elevated and whose imaging does not show high-risk radiological features — specifically, no intraluminal thrombus and a nonocclusive pattern of dissection.
Clinical Scenario
Patients are stratified by radiological risk profile. This pathway applies when risk factors for intracranial hemorrhage and ischemic stroke — such as intraluminal thrombus or high-grade stenosis — are absent, placing the patient in the lower-risk stratum that informs the antithrombotic approach.
Treatment Approach (partial overview)
An antiplatelet-based antithrombotic strategy is indicated in this setting, with the specific sequencing and total duration of therapy detailed in the full protocol.
The complete regimen — including therapy sequence, duration, and transition criteria — is available in the full structured protocol below.
References
DOI: 10.1161/STR.0000000000000457
- Patients are stratified according to radiological risk factors for intracranial hemorrhage (eg, large infarct, hemorrhagic transformation, and intracranial extension of the dissection) and important radiological risk factors for ischemic stroke (eg, presence of intraluminal thrombus and high-grade stenosis or occlusion).
- 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.
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