Cervical Artery Dissection: A Review of the Epidemiology, Pathophysiology, Treatment, and Outcome

Context: Cervical artery dissection (CAD) is a common cause of stroke in young adults. There is controversy over whether anticoagulation is superior to antiplatelet therapy in preventing stroke in patients with CAD, although meta-analyses to date have not shown any difference between the two treatments. Evidence Acquisition: We performed a PubMed search using each of the keywords: “Cervical artery dissection”, “Dissection”, “Carotid dissection”, and “Vertebral dissection” between January 1st, 1990 and July 1st 2015. We identified evidence-based peer-reviewed articles, including randomized trials, case series and reports, and retrospective reviews that encompass the epidemiology, clinical manifestations, pathophysiology, treatment, and outcome of cervical artery dissection. Results: This paper highlights the mechanisms of cervical artery dissection and stroke in patients with dissection as well as the natural history and treatment. Conclusions: Given the relatively rare incidence of this disease, multicenter studies with collaborative effort among stroke centers worldwide should be considered to enroll patients with cervical artery dissection in a randomized trial comparing the two treatments.