Extracranial Arterial Dissection

Anticoagulant therapy has been advocated consistentlyas the treatment of choice for cervical arterial dis-section in numerous published studies and reviews,1 but there is little evidence-based data to justify this assump-tion. Although dissection of the cervical arteries has long been established as a cause of ischemic and hemorrhagic stroke, the major obstacle to planning therapeutic studies has been the perception that this is a relatively rare phenomenon. However, rapid developments in accurate noninvasive imag-ing have shown cervical arterial dissection as a common, if not the most common, cause of ischemic stroke in persons 50 years of age. This has raised for the first time the realistic concept of a therapeutic trial of anticoagulants versus antiplatelet treatment. A recent Cochrane review2 cited a figure of 1000 patients in each therapeutic arm, and similar figures were calculated from the only prospective study published to date.3