Vertebral Artery Dissection with Elevated Risk of Extracranial or Intracranial Hemorrhage
Clinical Scenario
This protocol addresses vertebral artery dissection in patients who carry an elevated risk of extracranial hemorrhage — for example, those with a recent hemorrhage — or an elevated risk of intracranial hemorrhage, such as large infarct size, hemorrhagic transformation, or intradural extension of the extracranial dissection.
Treatment Approach
In this hemorrhage-risk setting, an antiplatelet-based approach — when considered safe — forms the foundation of antithrombotic management. The complete regimen, including sequencing, selection, and duration, is in the full protocol.
References
DOI: 10.1161/STR.0000000000000457
- 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.
- Otherwise, antiplatelet monotherapy could be used.
- It is reasonable that the duration of antithrombotic therapy in patients with cervical artery dissection be 3–6 mo.
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