International survey on the management of cervical artery dissection: assessing consensus and variability in practice

Cervical artery dissection (CAD) is a leading cause of stroke in young adults, accounting for up to 25% of strokes in this population. Despite its prevalence, management strategies vary widely due to limited large-scale randomized trials and inconsistent findings in the literature. This study aims to assess treatment practices for CAD and evaluate the consistency of clinical decision-making among stroke physicians using a structured survey. An international survey was distributed to stroke physicians and trainees, including participants in the STOP-CAD and TREAT-CAD studies. The survey explored patient characteristics influencing treatment decisions, preferred antithrombotics, treatment duration, and criteria for stopping therapy. Six case-based scenarios assessed initial treatment choices, follow-up imaging practices, and medication duration. Responses were analyzed using Krippendorff’s alpha to quantify inter-rater reliability and evaluate consensus among respondents. The survey was completed by 102 stroke physicians and trainees, revealing moderate agreement, with a Krippendorff’s alpha of 0.481. Significant variability was observed in CAD management, particularly in the choice of antithrombotic treatment and treatment duration. However, strong consensus was found regarding the use of follow-up imaging (99.16%), with computed tomography angiography (CTA) being the preferred modality (63.2%). The variability in CAD management highlights the need for further research to establish standardized, evidence-based guidelines. 102 physicians responded to a survey that included four general questions dealing with secondary prevention strategies in patients with cervical arterial dissections (CAD) and six case scenarios, each containing five identical questions dealing with acute and post-acute management. Only moderate agreement was observed in diagnosis and treatment related topics. There is an unmet need for randomized controlled studies aiming to look at diagnosis and treatment of patients with CAD.