This protocol addresses vertebral artery dissection in the specific clinical context of low (not elevated) bleeding risk combined with the presence of high-risk imaging findings — radiological features that increase the likelihood of ischemic stroke.
The patient presents with vertebral artery dissection and does not have elevated bleeding risk. Imaging reveals high-risk radiological features: an intraluminal thrombus, or an occlusive or high-grade stenotic dissection. Patients are stratified by radiological risk factors — including large infarct, hemorrhagic transformation, and intracranial extension — as well as ischemic-stroke risk factors such as the presence of intraluminal thrombus and high-grade stenosis or occlusion.
In patients with low bleeding risk who have high-risk radiological features, anticoagulation therapy is a central element of management — involving an initial parenteral phase followed by an oral phase. Full regimen details, sequencing, and duration are in the structured protocol.
DOI: 10.1161/STR.0000000000000457
The presence of radiographic high-risk features that are known predictors of ischemic stroke after dissection (such as severe stenosis or occlusion, intraluminal thrombus) in patients with low risk of bleeding may warrant anticoagulation therapy.
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).
Parenteral followed by oral anticoagulation may be considered in particular in patients at low risk of intracranial hemorrhage (small infarct size, no intradural extension, and no intracranial hemorrhage) but at high risk for ischemic stroke (eg, intraluminal thrombus, occlusive dissection).
It is reasonable that the duration of antithrombotic therapy in patients with cervical artery dissection be 3–6 mo.
View source ↗