Vertebral Artery Dissection with Low Bleeding Risk and Absence of High-Risk Radiological Features
In patients with vertebral artery dissection where bleeding risk is not elevated and high-risk radiological features are absent, the clinical picture guides a specific management pathway. This page summarises the key characteristics of this sub-population and offers a partial overview of the treatment direction.
Clinical Scenario
Bleeding risk is not elevated (low bleeding risk). Imaging shows absence of high-risk radiological features: no intraluminal thrombus is identified and the dissection is nonocclusive. Risk stratification accounts for radiological factors for both intracranial hemorrhage and ischemic stroke, including the presence or absence of intraluminal thrombus and the degree of stenosis or occlusion.
Treatment Direction (Partial)
In this setting, an endovascular approach directed at secondary stroke prevention is among the considerations — with an alternative surgical option available when the primary approach cannot be performed. The full eligibility criteria, sequencing, and conditions under which each option applies are detailed in the structured protocol.
Full regimen, criteria, and clinical algorithm available via the 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).
Angioplasty and stenting may be fairly safe and beneficial in a limited population of patients with flow-limiting stenosis who fail medical treatment.
Patients with cervical artery dissection with significant stenosis causing distal hemodynamic compromise AND recurrent ischemic stroke despite optimal medical treatment AND who can withstand surgery may be considered for stenting as a measure for secondary stroke prevention.
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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