Beyond vascular recanalization: precision medicine in cervical artery dissection guided by multiple mechanisms and multimodal imaging for brain functional recovery

Q: What is the clinical evidence from this study?

Study design: Review. Population: Cervical artery dissection (CAD). Intervention: Multimodal imaging-guided precision medicine, antithrombotic therapy, intravenous thrombolysis, and endovascular therapy. Primary outcome: Vascular recanalization and stroke recurrence.

Tao Li; Lei Li; Kexin Zhao; Jiaqi Dai; Xueliang TIAN; Xuanxiao Zhang; Shuo Yin; Wenjing Lan; H. Zhou

doi:10.3389/fphys.2025.1695764

January 30, 2026Frontiers in PhysiologyOpen Access

Beyond vascular recanalization: precision medicine in cervical artery dissection guided by multiple mechanisms and multimodal imaging for brain functional recovery

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Key result

Anticoagulants show no recanalization benefit over antiplatelets in cervical artery dissection.

Key Points

To review the pathological mechanisms, advanced imaging modalities, and clinico-anatomical classification frameworks of cervical artery dissection to optimize personalized recanalization strategies and functional recovery.
Synthesized evidence evaluating diagnostic modalities (high-resolution MRI, CTA, DSA, and ultrasound) and classification systems for cervical artery dissection.
Evaluated medical regimens—including intravenous thrombolysis within 4.5 hours and 3 to 6 months of antithrombotic therapy—alongside endovascular intervention techniques.
Intravenous thrombolysis with alteplase or tenecteplase within 4.5 hours of symptom onset demonstrates safety profiles and intracranial hemorrhage rates comparable to non-dissection stroke cohorts.
A clinical cohort study (n = 1,390) showed a 1.4% ipsilateral stroke or transient ischemic attack rate during antithrombotic therapy (≤6 months) versus 3.4% during post-treatment observation (>6 months), with equivalent event rates between antiplatelet (3.3%) and anticoagulant (2.0%) therapy.
A 2024 imaging classification categorizes dissection into four types (type I to type IVB) to guide therapy from medical antithrombotic prevention to emergent endovascular recanalization based on stenosis severity and hemodynamic status.

PICO

P

Population

Young and middle-aged adults with cervical artery dissection evaluated across multiple clinical, imaging, and translational studies.

I

Intervention / Comparator

Multimodal imaging-guided precision medicine, antithrombotic therapy, intravenous thrombolysis, and endovascular therapy

O

Primary Outcome

Vascular recanalization and stroke recurrence

Limitations

Current evidence base suffers from a scarcity of high-quality evidence-based studies, consisting mostly of case reports and small retrospective series lacking multicenter RCT validation.
Lack of reliable predictive biomarkers for spontaneous recanalization and thromboembolic risk stratification.
Conventional CT and MRI exhibit 20%–30% false-negative rates for dynamic intramural hematoma evolution.
Long-term efficacy of endovascular therapy and classification-guided frameworks requires validation through large-scale prospective studies.

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Implication

This review evaluates treatment strategies for cervical artery dissection, highlighting implications for personalized therapy.

Abstract

Cervical artery dissection (CAD), a critical etiological contributor of stroke in young adults, exerts direct influence on neurological prognosis through its vascular recanalization outcomes. However, pathological heterogeneity and ongoing controversies surrounding treatment strategies hinder the optimization of clinical decision-making; its prognosis is often not favorable. At present, there are a relative paucity of studies on recanalization of CAD. This review provides a concise overview of the pathological mechanisms and clinical challenges associated with CAD, along with recent advancements in advanced imaging modalities and clinico-anatomical classification systems. Furthermore, we critically evaluate current therapeutic paradigms and factors influencing recanalization while elucidating potential biological mechanisms underlying vascular restoration. A systematic analysis of translational utility in animal models is presented. Finally, based on the latest research progress in CAD and vessel recanalization, prospects are outlined aiming to establish a theoretical foundation for developing personalized and precise therapeutic approaches targeting CAD recanalization from multidimensional perspectives, and to offer reference for subsequent research.

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Cite This Study

Li et al. (2026) conducted a review in Cervical artery dissection (CAD). Multimodal imaging-guided precision medicine, antithrombotic therapy, intravenous thrombolysis, and endovascular therapy was evaluated on Vascular recanalization and stroke recurrence. Spontaneous vascular recanalization in cervical artery dissection occurs in 30%–60% of patients (80% within 6 months), with equivalent 1-year recanalization between anticoagulants and antiplatelets.

synapsesocial.com/papers/6980fe57c1c9540dea810623 https://doi.org/10.3389/fphys.2025.1695764

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Beyond vascular recanalization: precision medicine in cervical artery dissection guided by multiple mechanisms and multimodal imaging for brain functional recovery

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Beyond vascular recanalization: precision medicine in cervical artery dissection guided by multiple mechanisms and multimodal imaging for brain functional recovery

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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