Treatment of Vertebral Artery Dissection When Bleeding Risk Is Not Elevated and High-Risk Radiological Features Are Absent

Clinical Scenario

This protocol addresses vertebral artery dissection in patients whose bleeding risk is not elevated (not elevated or moderate) and in whom key high-risk radiological features are absent — specifically, no intraluminal thrombus and a nonocclusive pattern of dissection.

Radiological Risk Profile

Patients with cervical artery dissection are stratified based on radiological findings that signal risk for ischemic stroke or intracranial hemorrhage. This scenario applies when all of the following are confirmed:

No intraluminal thrombus on imaging
Nonocclusive dissection (no high-grade stenosis or occlusion)
Bleeding risk not elevated (not elevated or moderate)

Treatment Approach

In this specific setting, an antiplatelet-based antithrombotic strategy is appropriate. The full protocol specifies agent selection and all further management details.

Instant Access to Structured Evidence-Based Regimens

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).

Otherwise, antiplatelet monotherapy could be used.

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