Cervical Artery Dissection Patients Have Low Stroke Rate
Tuesday, March 03, 2015 06:26 AM

Cervical artery dissection begins as a tear in a carotid artery in the neck, which causes blood to pump into arterial walls and split their layers.The condition is rare, but it is one of the most common cause of strokes in young and middle-age adults , accounting for between 10% and 25% of strokes in this age group, the researchers noted. Studies also suggest that the secondary stroke risk is as high as 20% in these patients, especially if they present local symptoms, such as headache, or with stroke or transient ischemic attack.

"Some people have suggested that the rate of recurrence is very high in these patients -- as high as 15% in the first few weeks. This study tells us that the rate of recurrence is much lower -- closer to 2%. This is very reassuring for patients, and it probably means that it doesn't really matter which [of the pharmaceutical treatments] you give."

Because recurrences were so rare, a definitive study comparing the efficacy of the two treatment strategies would require a sample size of close to 10,000 patients.

"The risk of early recurrence of stroke has led many clinicians to advocate the use of anticoagulation from presentation until 3 to 6 months after dissection," the researchers wrote. "However, others believe that antiplatelet drugs might be sufficient."

The Cervical Artery Dissection in Stroke Study (CADISS) included 118 carotid and 132 vertebral artery dissection patients treated at specialized stroke or neurology centers in the U.K. and Australia. All patients were enrolled and randomized within 7 days of symptom onset, and the patients were randomly assigned to receive either antiplatelet or anticoagulant drugs for 3 months.

During 3 months of follow-up, very few strokes occurred among participants in the Cervical Artery Dissection in Stroke Study (CADISS), suggesting that much larger studies would be needed to fully understand the impact of different treatments in this patient population.  Just 2% of the 250 patients enrolled in the study had recurrent strokes during this observation period, which is a much lower percentage than has been reported by some.

Source:  http://www.medpagetoday.com/MeetingCoverage/ISCCardioEdition/49994