Vertebral artery dissection management

in Vertebral and Subclavian Disease

Applied

Type

Reinforcement

Confidence

90%

Created

Mar 19, 2026

Evidence

1 source

Rationale

The integration of the Loufopoulos 2025 meta-analysis provides high-level evidence (Level 1a) that reinforces the existing CADISS trial findings. This update confirms that the choice between antiplatelet and anticoagulant therapy remains at the clinician's discretion as outcomes are comparable. I also expanded the abbreviation DOACs on its first use in the section.

Evidence

Loufopoulos G et al. Antithrombotic treatment of cervical artery dissection: A systematic review and meta-analysis. Vascular Medicine. 2025. PMID: 40552976.
Verified source
PubMedDOI

Content Changes

* **Epidemiology:** Common non-atherosclerotic cause of posterior circulation ischemia, especially in younger patients (<50 years).
* **Clinical presentation:** Neck pain, headache, posterior circulation transient ischemic attack (TIA)/stroke; may follow minor trauma or be spontaneous.
* **Diagnosis:**
  + **computed tomography angiography (CTA) or magnetic resonance angiography (MRA)** with fat-suppressed T1 sequences to identify intramural hematoma.
  + Consider MRI/MRA for serial follow-up.
* **Medical management (first-line):**
  + **Antiplatelet therapy** (aspirin or clopidogrel) OR **anticoagulation** (heparin bridge to warfarin or DOACs).direct oral anticoagulants (DOACs)).
  + **CADISS trial [@markus2015]:** Randomized comparison showed no significant difference in recurrent stroke/TIA between antiplatelet and anticoagulation at 3 months.
  + A systematic review and meta-analysis confirmed that there is no significant difference in the risk of recurrent stroke or death between antiplatelet and anticoagulant therapy [@loufopoulos2025].
  + Choice is individualized based on dissection extent, pseudoaneurysm, and patient factors.
* **Endovascular therapy:** Reserved for patients with recurrent ischemic events despite medical therapy, or flow-limiting stenosis/pseudoaneurysm.
* **Duration:** Most dissections heal within 3–6 months; repeat imaging to guide duration of antithrombotic therapy.
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