Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Oct 6;2010(10):CD000255.
doi: 10.1002/14651858.CD000255.pub2.

Antithrombotic drugs for carotid artery dissection

Philippe Lyrer  1 , Stefan Engelter
Affiliations
Meta-Analysis

Antithrombotic drugs for carotid artery dissection

Philippe Lyrer et al. Cochrane Database Syst Rev. .

Abstract

Background: Extracranial internal carotid artery dissection (eICAD) is a leading cause of stroke in younger patients.

Objectives: 1. To determine whether, in patients with eICAD, treatment with anticoagulants, antiplatelet agents or control was associated with a better functional outcome. 2. To compare, among patients treated with either anticoagulants or antiplatelet agents, the risk of ischaemic strokes and major bleeding episodes.

Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched 3 October 2009). In addition, we performed comprehensive searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2009), MEDLINE (January 1966 to November 2009) and EMBASE (January 1980 to November 2009), checked all relevant papers for additional eligible studies and contacted authors and researchers in the field.

Selection criteria: Randomised controlled trials, controlled clinical trials and non-randomised studies (if they reported on outcome stratified by antithrombotic treatment and included at least four patients) of anticoagulants or antiplatelet agents for the treatment of extracranial internal carotid artery dissection. Two review authors independently extracted data.

Data collection and analysis: Primary outcomes were death (all causes) and death or disability. Secondary outcomes were ischaemic stroke, symptomatic intracranial haemorrhage, and major extracranial haemorrhage during the reported follow-up period. The first choice treatment was taken for analyses.

Main results: We did not find any completed randomised trials. Comparing antiplatelets with anticoagulants across 36 observational studies (1285 patients), there were no significant differences in the odds of death (Peto odds ratio (Peto OR) 2.02, 95% CI 0.62 to 6.60), or the occurrence of ischaemic stroke (OR 0.63, 95% CI 0.21 to 1.86) (34 studies, 1262 patients). For the outcome of death or disability, there was a non-significant trend in favour of anticoagulants (OR 1.77, 95% CI 0.98 to 3.22; P = 0.06) (26 studies, 463 patients). Symptomatic intracranial haemorrhages (5/627; 0.8%) and major extracranial haemorrhages (7/425; 1.6%) occurred only in the anticoagulation group; however, for both these outcomes, the estimates were imprecise and indicated no significant difference between the two treatment modalities.

Authors' conclusions: There were no randomised trials comparing either anticoagulants or antiplatelet drugs with control, thus there is no evidence to support their routine use for the treatment of extracranial internal carotid artery dissection. There were also no randomised trials that directly compared anticoagulants with antiplatelet drugs and the reported non-randomised studies did not show any evidence of a significant difference between the two.

PubMed Disclaimer

Conflict of interest statement

Both authors were investigators in the Engelter 2000 study.

Figures

1.1
1.1. Analysis
Comparison 1 Antiplatelet drugs versus anticoagulants, Outcome 1 Death from all causes.
1.2
1.2. Analysis
Comparison 1 Antiplatelet drugs versus anticoagulants, Outcome 2 Death or disability.
1.3
1.3. Analysis
Comparison 1 Antiplatelet drugs versus anticoagulants, Outcome 3 Ischaemic stroke (during follow‐up).
1.4
1.4. Analysis
Comparison 1 Antiplatelet drugs versus anticoagulants, Outcome 4 Symptomatic intracranial haemorrhage.
1.5
1.5. Analysis
Comparison 1 Antiplatelet drugs versus anticoagulants, Outcome 5 Major extracranial haemorrhage.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Arauz 2006 {published data only}
    1. Arauz A, Hoyos L, Espinoza C, Cantú C, Barinagarrementeria F, Román G. Dissection of cervical arteries: Long‐term follow‐up study of 130 consecutive cases. Cerebrovascular Diseases 2006;22(2‐3):150‐4. - PubMed
Ast 1993 {published data only}
    1. Ast G, Woimant F, Georges B, Laurian C, Haguenau M. Spontaneous dissection of the internal carotid artery in 68 patients. European Journal of Medicine 1993;2:466‐72. - PubMed
Biller 1986 {published data only}
    1. Biller J, Hingtgen WL, Adams HP Jr, Smoker WRK, Godersky JC, Toffol GJ. Cervicocephalic arterial dissections. A ten‐year experience. Archives of Neurology 1986;43:1234‐8. - PubMed
Biousse 1998 {published data only}
    1. Biousse V, Schaison M, Touboul P‐J, D'Anglejan‐Chatillon J, Bousser M‐G. Ischemic optic neuropathy associated with internal carotid artery dissection. Archives of Neurology 1988;55:715‐9. - PubMed
Bogousslavsky 1987b {published data only}
    1. Bogousslavsky J, Despland P‐A, Regli F. Spontaneous carotid artery dissection with acute stroke. Archives of Neurology 1987;44:137‐40. - PubMed
Campos 2007 {published and unpublished data}
    1. Campos CR, Calderaro M, Scaff M, Conforto AB. Primary headaches and painful spontaneous cervical artery dissection. Journal of Headache and Pain 2007;8(3):180‐4. - PMC - PubMed
    1. Campos CR, Evaristo EF, Yamamoto FI, Puglia P Jr, Lucato LT, Scaff M. Spontaneous cervical carotid and vertebral arteries dissection: study of 48 patients. Arquivos de Neuro‐psiquiatria 2004;62(2B):492‐8. - PubMed
Caso 2004 {published and unpublished data}
    1. Caso V, Paciaroni M, Corea F, Hamam M, Milia P, Pelliccioli GP, et al. Recanalization of cervical artery dissection: influencing factors and role in neurological outcome. Cerebrovascular Diseases 2004;17:93–7. - PubMed
Chen 1984 {published data only}
    1. Chen ST, Ryu SJ, Hsi MS. Cervico‐cerebral artery dissection. Journal of the Formosan Medical Association 1984;83:846‐61. - PubMed
Colella 1996 {published data only}
    1. Colella JJ, Diamond DL. Blunt carotid injury: reassessing the role of anticoagulation. American Surgeon 1996;62:212‐7. - PubMed
De Bray 1989 {published data only}
    1. Bray JM, Dubas F, Joseph PA, Causeret H, Pasquier JP, Emile J. [Etude ultrasonique de 22 dissections carotidiennes]. Revista de Neurologia 1989;145(10):702‐9. - PubMed
Dziewas 2003 {published and unpublished data}
    1. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. Cervical artery dissection: clinical features, risk factors, therapy and outcome in 126 patients. Journal of Neurology 2003;250(10):1179‐84. - PubMed
Eachempati 1998 {published data only}
    1. Eachempati SR, Vaslef SN, Sebastian MW, Reed RL. Blunt vascular injuries of the head and neck: is heparinisation necessary?. Journal of Trauma 1998;45(6):997‐1004. - PubMed
Eljamel 1990 {published data only}
    1. Eljamel MSM, Humphrey PRD, Shaw MDM. Dissection of the cervical internal carotid artery. The role of doppler/duplex studies and conservative management. Journal of Neurology, Neurosurgery and Psychiatry 1990;53:379‐83. - PMC - PubMed
Engelter 2000 {published data only}
    1. Engelter ST, Lyrer PA, Kirsch EC, Steck AJ. Long‐term follow‐up after extracranial carotid artery dissection. European Neurology 2000;44:199‐204. - PubMed
Friedman 1980 {published data only}
    1. Friedman WA, Day AL, Quisling RG, Sypert GW, Rhoton AL Jr. Cervical carotid dissecting aneurysms. Neurosurgery 1980;7:207‐14. - PubMed
Georgiadis 2009 {published data only}
    1. Georgiadis D, Arnold M, Buedingen HC, Valko P, Sarikaya H, Rousson V, et al. Aspirin vs anticoagulation in carotid artery dissection: a study of 298 patients. Neurology 2009;72:1810‐5. - PubMed
Gonzales‐Portillo 2002 {published data only}
    1. Gonzales‐Portillo F, Bruno A, Biller J. Outcome of extracranial cervicocephalicarterial dissections: a follow‐up study. Neurological Research 2002;24:395–8. - PubMed
Kaps 1990 {published data only}
    1. Kaps M, Dorndorf W, Damian MS, Agnoli L. Intracranial haemodynamics in patients with spontaneous carotid artery dissection. European Archives of Psychiatry and Neurological Sciences 1990;239:246‐56. - PubMed
Landre 1987 {published data only}
    1. Landre E, Roux FX, Cioloca C. [Dissection spontanee de la carotide interne exocranienne]. Presse Medicale 1987;16:1273‐6. - PubMed
Lepojärvi 1988 {published data only}
    1. Lepojärvi M, Tarkka M, Leinonen A, Kallanranta T. Spontaneous dissection of the internal carotid artery. Acta Chirurgica Scandinavica 1988;154:559‐66. - PubMed
Li 1994 {published data only}
    1. Li MS, Smith BM, Espinosa J, Brown RA, Richardson P, Ford R. Non‐penetrating trauma to the carotid artery: seven cases and a literature review. Journal of Trauma 1994;36:265‐72. - PubMed
Luken 1979 {published data only}
    1. Luken MG III, Ascherl GF Jr, Correll JM, Hilal SK. Spontaneous dissecting aneurysm of the extracranial internal carotid artery. Clinical Neurosurgery 1979;26:353‐75. - PubMed
Marx 1987 {published data only}
    1. Marx A, Messing B, Storch B, Busse O. [Spontane dissektionen hirnversorgender arterien]. Der Nervenarzt 1987;58:8‐18. - PubMed
Metso 2009 {published and unpublished data}
    1. Metso TM, Metso AJ, Salonen O, Haapaniemi E, Putaala J, Artto V, et al. Adult cervicocerebral artery dissection: a single‐center study of 301 Finnish patients. European Journal of Neurology 2009;16(6):656‐61. - PubMed
Miller‐Fisher 1978 {published data only}
    1. Miller‐Fisher C, Ojemann RG, Roberson GH. Spontaneous dissection of cervico‐cerebral arteries. Canadian Journal of Neurological Sciences 1978;5:9‐19. - PubMed
Mokri 1986 {published data only}
    1. Mokri B, Sundt TM, Houser W, Piepgras DG. Spontaneous dissection of the cervical internal carotid artery. Annals of Neurology 1986;19:126‐38. - PubMed
Müller‐Forell 1989 {published data only}
    1. Müller‐Forell W, Rothacher G, Krämer G. [Carotis‐dissektionen]. Radiologe 1989;29:432‐6. - PubMed
Pieri 2007 {published and unpublished data}
    1. Pieri A, Spitz M, Valiente RA, Avelar WM, Silva GS, Massaro AR. Spontaneous carotid and vertebral arteries dissection in a multiethnic population. Arquivos de Neuro‐psiquiatria 2007;65:1050‐5. - PubMed
Richaud 1980 {published data only}
    1. Richaud J, Lagarrigue J, Lazorthes Y. [Les lésions traumatiques fermées de la carotide interne au cou. A propos de 17 cas]. Neurochirurgie 1980;26:109‐21. - PubMed
Schievink 1990 {published data only}
    1. Schievink W I, Limburg M. [Dissectie van cervicale arterien als oorzaak van hersenischemie of uitival van hersenzenuwen]. Nederlands Tijdschrift voor Geneeskunde 1990;134:1843‐8. - PubMed
Sellier 1983 {published data only}
    1. Sellier N, Chiras J, Benhamou M, Bories J. Spontaneous dissection of the internal carotid artery. Journal of Neuroradiology 1983;10:243‐59. - PubMed
Touze 2003 {published data only}
    1. Touze E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL. Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. Neurology 2003;61(10):1347‐51. - PubMed
Treiman 1996 {published data only}
    1. Treiman GS, Treiman RL, Foran RF, Levin PM, Cohen JL, Wagner WH, et al. Spontaneous dissection of the internal carotid artery: a nineteen‐year clinical experience. Journal of Vascular Surgery 1996;24(4):597‐605. - PubMed
Vanneste 1984 {published data only}
    1. Vanneste JAL, Davies G. Spontaneous dissection of cervical internal carotid artery. Clinical Neurology and Neurosurgery 1984;86(4):307‐14. - PubMed
Wahl 2002 {published data only}
    1. Wahl WL, Brandt MM, Thompson BG, Taheri PA, Greenfield LJ. Antiplatelet therapy: an alternative to heparin for blunt carotid injury. Journal of Trauma 2002;52:896‐901. - PubMed
Zelenock 1982 {published data only}
    1. Zelenock GB, Kazmers A, Whitehouse WM Jr, Graham LM, Erlandson EE, Cronenwett JL, et al. Extracranial internal carotid artery dissections. Archives of Surgery 1982;117:425‐32. - PubMed

References to studies excluded from this review

Alimi 1996 {published data only}
    1. Alimi YS, Mauro P, Fiacre E, Magnan J, Juhan C. Blunt injury to the internal carotid artery at the base of the scull: Six cases of venous graft restoration. Journal of Vascular Surgery 1996;24:249‐57. - PubMed
Andre‐Sereys 1996 {published data only}
    1. Andre‐Serys P, Petit E, Benrabah R, Abanouh A, Rancurel G, Haut J. [Dissection spontanée de la carotide interne en milieu ophtalmologique. A propos de dix cas]. Journal Français d'Ophtalmologie 1996;19(4):259‐64. - PubMed
Arnold 2006 {published data only}
    1. Arnold M, Kappeler L, Georgiadis D, Berthet K, Keserue B, Bousser MG, et al. Gender differences in spontaneous cervical artery dissection. Neurology 2006;67:1050‐2. - PubMed
Bakke 1996 {published data only}
    1. Bakke S J, Smith H ‐J, Kerty E, Dahl A. Cervicocranial artery dissection. Detection by Doppler ultrasound and MR angiography. Acta Radiologica 1996;37:529‐34. - PubMed
Barbour 1994 {published data only}
    1. Barbour PJ, Castaldo JE, Rae Grant AD, et al. Internal carotid artery redundancy is significantly associated with dissection. Stroke 1994;25:1201‐6. - PubMed
Bassetti 1996 {published data only}
    1. Bassetti C, Carruzzo A, Sturzenegger M, Tuncdogan E. Recurrence of cervical artery dissection. Stroke 1996;27:1804‐7. - PubMed
Bassi 2003 {published data only}
    1. Bassi P, Lattuada P, Gomitoni A. Cervical cerebral artery dissection: a multicenter prospective study (preliminary report). Neurological Sciences 2003;24 Suppl 1:S4‐S7. - PubMed
Baumgartner 2001 {published data only}
    1. Baumgartner RW, Arnold M, Baumgartner I, Mosso M, Goenner F, Studer A, et al. Carotid dissection with and without ischemic events. Neurology 2001;57:827‐32. - PubMed
Berne 2004 {published data only}
    1. Berne JD, Norwood SH, McAuley CE, Villareal DH. Helical computed tomographic angiography: an excellent screening test for blunt cerebrovascular injury. Journal of Trauma 2004;57:11‐7. - PubMed
Biffl 2002 {published data only}
    1. Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. Journal of Trauma 1999;47(5):845‐52. - PubMed
    1. Biffl WL, Moore EE, Ryu RK, Offner PJ, Novak Z, Coldwell DM, et al. The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. Annals of Surgery 1998;228(4):462‐70. - PMC - PubMed
    1. Biffl WL, Ray CE Jr, Moore EE, Franciose RF, Aly S, Heyrosa MG, et al. Treatment‐related outcomes from cerebrovascular injuries. Annals of Surgery 2002;235:699‐707. - PMC - PubMed
Biousse 1995 {published data only}
    1. Biousse VD, Anglejan‐Chatillon J, Touboul P‐J, Amarenco P, Bousser M‐G. Time course of symptoms in carotid artery dissections. Stroke 1995;26:235‐9. - PubMed
Bradac 1981 {published data only}
    1. Bradac GB, Kaernbach A, Bolk‐Weischedel D, Finck GA. Spontaneous dissecting aneurysm of cervical cerebral arteries. Neuroradiology 1981;21:149‐54. - PubMed
Bui 1993 {published data only}
    1. Bui LN, Brant‐Zawadzki M, Verghese P, Gillan G. Magnetic resonance angiography of cervicocranial dissection. Stroke 1993;24:126‐31. - PubMed
Carrillo 1999 {published data only}
    1. Carrillo EH, Osborne DL, Spain DA, Miller FB, Senler SO, Richardson JD. Blunt carotid artery injuries: difficulties with the diagnosis prior to neurologic event. Journal of Trauma 1996;46(6):1120‐5. - PubMed
Chabrier 2003 {published data only}
    1. Chabrier S, Lasjaunias P, Husson B, Landrieu P, Tardieu M. Ischaemic stroke from dissection of the craniocervical arteries in childhood: report of 12 patients. European Journal of Paediatric Neurology 2003;7:39‐42. - PubMed
Chan 2001 {published data only}
    1. Chan C, Paine M, O'Day J. Carotid dissection: a common cause of Horner's syndrome. Clinical and Experimental Ophthalmology 2001;29:411‐5. - PubMed
Cimini 2004 {published data only}
    1. Cimini N, D'Andrea P, Gentile M, Berletti R, Ferracci F, Candeago RM, et al. Cervical artery dissection: a 5‐year prospective study in the Belluno district. European Neurology 2004;52:207‐10. - PubMed
Cusmano 1988 {published data only}
    1. Cusmano F, Piazza P, Donatis M, Montanari E, Saginario A, Bassi P. [Dissecazione dell'arteria carotide interna. Casistica personale e revisione della letteratura]. La Radiologia Medica 1988;76:262‐73. - PubMed
Davis 1990 {published data only}
    1. Davis JW, Holbrook TL, Hoyt DB, Mackersie RC, Field TO, Shackford SR. Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment. Journal of Trauma 1990;30:1514‐7. - PubMed
Desfontaines 1995 {published data only}
    1. Desfontaines P, Despland PA. Dissection of internal carotid artery: etiology, symptomatology, clinical and neurosonological follow‐up, and treatment in 60 consecutive cases. Acta Neurologica Belgica 1995;95:226‐34. - PubMed
Djouhri 2000 {published data only}
    1. Djouhri H, Guillon B, Brunereau L, Levy C, Bousson V, Biousse V, et al. MR Angiography for the long‐term follow‐up of dissecting aneurysms of the extracranial internal carotid artery. American Journal of Roentgenology 2000;174:1137‐40. - PubMed
Dreier 2004 {published data only}
    1. Dreier JP, Lurtzing F, Kappmeier M, Bohner G, Klingebiel R, Leistner S, et al. Delayed occlusion after internal carotid artery dissection under heparin. Cerebrovascular Diseases 2004;18(4):296‐303. - PubMed
Droste 2001 {published data only}
    1. Droste DW, Junker K, Stogbauer F, Lowens S, Besselmann M, Braun B, et al. Clinically silent circulating microemboli in 20 patients with carotid or vertebral artery dissection. Cerebrovascular Diseases 2001;12(3):181‐5. - PubMed
Early 1991 {published data only}
    1. Early TF, Gregory RT, Wheeler JR, Snyder SO Jr, Gayle RG, Parent FN III, et al. Spontaneous carotid artery dissection: duplex scanning in diagnosis and management. Journal of Vascular Surgery 1991;14:391‐7. - PubMed
Ehrenfeld 1976 {published data only}
    1. Ehrenfeld WK, Wylie EJ. Spontaneous dissection of the internal carotid artery. Archives of Surgery 1976;111:1294‐301. - PubMed
Fabian 1990 {published data only}
    1. Fabian TC, George SM Jr, Croce MA, Mangiante EC, Voeller GR, Kudsk KA. Carotid artery trauma: management based on mechanism of injury. Journal of Trauma 1990;30:953‐61. - PubMed
Fabian 1996 {published data only}
    1. Fabian T, Patton JH Jr, Croce MA, Minard G, Kudsk KA, Prichard FE. Blunt carotid injury: importance of early diagnosis and anticoagulant therapy. Annals of Surgery 1996;223(5):513‐25. - PMC - PubMed
Gelbert 1991 {published data only}
    1. Gelbert F, Assouline E, Hodes JE, Reizine D, Woimant F, George B, et al. MRI in spontaneous dissection of vertebral and carotid arteries. 15 cases studies at 0.5 Tesla. Neuroradiology 1991;33:111‐3. - PubMed
Guillon 1999 {published data only}
    1. Guillon B, Brunereau L, Biousse V, Djouhri H, Levy C, Bousser MG. Long‐term follow‐up on aneurysms developed during extracranial internal artery dissection. Neurology 1999;53:117‐22. - PubMed
Hughes 2000 {published data only}
    1. Hughes KM, Collier B, Green KA, Kurek S. Traumatic carotid artery dissection: a significant incidental finding. American Surgeon 2000;66(11):1023‐7. - PubMed
Kerwin 2001 {published data only}
    1. Kerwin AJ, Bynoe RP, Murray J, Hudson ER, Close TP, Gifford RRM, et al. Liberalized screening for blunt carotid and vertebral artery injuries is justified. Journal of Trauma 2001;51:308‐14. - PubMed
Kirsch 1998 {published data only}
    1. Kirsch E, Kaim A, Engelter S, Lyrer P, Stock KW, Bongartz G, et al. MR angiography in internal carotid artery dissection: improvement of diagnosis by selective demonstration of the intramural haematoma. Neuroradiology 1998;40:704‐9. - PubMed
Koennecke 1997 {published data only}
    1. Koennecke H‐C, Trocio SH, Mast H, Mohr JP. Microemboli on transcranial doppler in patients with spontaneous carotid artery dissection. Journal of Neuroimaging 1997;7:217‐20. - PubMed
Landini 1996 {published data only}
    1. Landini G, Cordopatri F, Scarti L, Spolveri S, Pennati P, Rosselli A. [Dissezione dei vasi epiaortici: una patalogia emergente come causa di ischemia cerebrale focale. Valutazione di una casistica di 7 pazienti]. Annali Italiani de Medicina Interna 1996;11:12‐6. - PubMed
Leclerc 1998 {published data only}
    1. Leclerc X, Lucas C, Godefroy O, Tessa H, Martinat P, Leys D, et al. Helical CT for the follow‐up of cervical artery dissections. American Journal of Neuroradiology 1998;19:831‐7. - PMC - PubMed
Lee 2006 {published data only}
    1. Lee VH, Brown RD, Jr, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population‐based study. Neurology 2006;67:1809‐12. - PubMed
Leys 1995 {published data only}
    1. Leys D, Moulin TH, Stoikovic T, Begey S, Chavot D, DONALD Investigators. Follow up of patients with history of cervical artery dissection. Cerebrovascular Diseases 1995;5:43‐9.
Lisovoski 1991 {published data only}
    1. Lisovoski F, Rousseaux P. Cerebral infarction in young people: a study of 148 patients with early cerebral angiography. Journal of Neurology, Neurosurgery and Psychiatry 1991;54:576‐9. - PMC - PubMed
Lucas 1998 {published data only}
    1. Lucas C, Moulin T, Deplanque D, Tatu L, Chavot D, DONALD investigators. Stroke patterns of internal carotid artery dissection in 40 patients. Stroke 1998;29:2646‐8. - PubMed
Miller 2001 {published data only}
    1. Miller PR, Fabian TC, Bee TK, Timmons S, Chamsuddin A, Finkle R, et al. Blunt cerebrovascular injuries: diagnosis and treatment. Journal of Trauma 2001;51:279‐86. - PubMed
Mokri 1990 {published data only}
    1. Mokri B. Traumatic and spontaneous extracranial internal carotid artery dissections. Journal of Neurology 1990;237:356‐61. - PubMed
Molina 2000 {published data only}
    1. Molina CA, Alvarez‐Sabin J, Schonewille W, Montaner J, Rovira A, Abilleira S, et al. Cerebral microembolism in acute spontaneous internal carotid artery dissection. Neurology 2000;55:1738‐40. - PubMed
Morgan 1994 {published data only}
    1. Morgan MK, Sekhon LHS. Extra cranial‐intracranial saphenous vein bypass for carotid or vertebral artery dissections: a report of six cases. Journal of Neurosurgery 1994;80:237‐46. - PubMed
Mueller 2000 {published data only}
    1. Mueller TB, Luther B, Hort W, Neumann‐Haefelin T, Aulich A, Sandmann W. Surgical treatment of 50 carotid dissections: indications and results. Journal of Vascular Surgery 2000;31:980‐8. - PubMed
Müllges 1992 {published data only}
    1. Müllges W, Ringelstein EB, Leibold M. Non‐invasive diagnosis of internal carotid artery dissections. Journal of Neurology, Neurosurgery and Psychiatry 1992;55:98‐104. - PMC - PubMed
Nishino 2008 {published data only}
    1. Nishino A, Suzuki I, Utsunomiya A, Suzuki S, Uenohara H, Sakurai Y. Clinical manifestation and treatment strategy for non‐hemorrhagic cerebral arterial dissection. Acta Neurochirurgica Supplement 2008;103:57‐60. - PubMed
O'Dwyer 1980 {published data only}
    1. O'Dwyer JA, Moscow N, Trevor R, Ehrenfeld WK, Newton TH. Spontaneaous dissection of the carotid artery. Radiology 1980;137:379‐85. - PubMed
Oliveira 2001 {published data only}
    1. Oliveira V, Batista P, Soares F, Ferro JM. HITS in internal carotid artery dissection. Cerebrovascular Diseases 2001;11:330‐4. - PubMed
Parenti 1989 {published data only}
    1. Parenti G, Marconi F, Canapicchi R, Puglioli M, Giraldi C. Spontaneous recanalization of carotid artery occlusion following non traumatic dissection. Italian Journal of Neurological Sciences 1989;10:361‐7. - PubMed
Pelkonen 2003 {published data only}
    1. Pelkonen O, Tikkakoski T, Leinonen S, Pyhtinen J, Lepojarvi M, Sotaniemi K. Extracranial internal carotid and vertebral artery dissections: angiographic spectrum, course and prognosis. Neuroradiology 2003;45:71‐7. - PubMed
Perry 1980 {published data only}
    1. Perry MO, Snyder WH, Thal ER. Carotid artery injuries caused by blunt trauma. Annals of Surgery 1980;192:74‐7. - PMC - PubMed
Petro 1987 {published data only}
    1. Petro GR, Witwer GA, Cacayorin ED, Hodge CJ, Bredenberg CE, Jastremski MS, et al. Spontaneous dissection of the cervical internal carotid artery: correlation of arteriography, CT and pathology. American Journal of Roentgenology 1987;148:393‐8. - PubMed
Power 1991 {published data only}
    1. Power T, Hanlon D, Brillman J. Dissections of the cervicocerebral arteries. Annals of Emergency Medicine 1991;20:1032‐5. - PubMed
Pozzati 1990 {published data only}
    1. Pozatti E, Giuliani G, Acciarri N, Nuzzo G. Long term follow up of occlusive cervical carotid dissection. Stroke 1990;21:528‐31. - PubMed
Pretre 1994 {published data only}
    1. Pretre R, Reverdin A, Kolonji T, Faidutti B. Blunt carotid artery injury: difficult therapeutic approaches for an underrecognized entity. Surgery 1994;115:375‐81. - PubMed
Provenzale 1995 {published data only}
    1. Provenzale JM, Barboriak DP, Taveras JM. Exercise related dissection of craniocervical arteries: CT, MR, and angiographic findings. Journal of Computer Assisted Tomography 1995;19:268‐76. - PubMed
Schievink 1994 {published data only}
    1. Schievink WI, Piepgras DG, McCaffrey TV, Mokri B. Surgical treatment of extracranial carotid artery dissecting aneurysms. Neurosurgery 1994;35:809‐15. - PubMed
Sperling 1996 {published data only}
    1. Sperling W, Kolominski P, Pfau M, Huk WJ, Stefan H. Dissection of the carotid and vertebral arteries ‐ diagnosis and treatment [Die dissektion der arteria carotis und arteria vertebralis ‐ diagnostik und therapie]. Fortschritte der Neurologie‐Psychiatrie 1996;64:153‐60. - PubMed
Steiger 1988 {published data only}
    1. Steiger H J. [Zur behandlung der traumatischen karotisdissektion]. Neurochirurgia 1988;31:128‐33. - PubMed
Steinke 1994 {published data only}
    1. Steinke W, Rautenberg W, Schwartz A, Hennerici M. Noninvasive monitoring of internal carotid artery dissection. Stroke 1994;25:998‐1005. - PubMed
Stringer 1980 {published data only}
    1. Stringer WL, Kelly DL. Traumatic dissection of the extracranial internal carotid artery. Neurosurgery 1980;6:123‐30. - PubMed
Sturzenegger 1995 {published data only}
    1. Sturzenegger M. Spontaneous internal carotid artery dissection: early diagnosis and management in 44 patients. Journal of Neurology 1995;242:231‐8. - PubMed
    1. Sturzenegger M, Mattle HP, Rivoir A, Baumgartner RW. Ultrasound findings in carotid artery dissection. Neurology 1995;45:691‐8. - PubMed
Sue 1992 {published data only}
    1. Sue DE, Brant‐Zawadzki MN, Chance J. Dissection of cranial arteries in the neck: correlation of MRI and angiography. Neuroradiology 1992;34:273‐8. - PubMed
Thie 1993 {published data only}
    1. Thie A, Helmer D, Lachenmayer L, Janzen RWC, Kunze K. Bilateral blunt traumatic dissections of the extracranial internal carotid artery: report of eleven cases and review of the literature. Cerebrovascular Diseases 1993;3:295‐303.
Touze 2001 {published data only}
    1. Touze E, Randoux B, Meary E, Arquizan C, Meder JF, Mas JL. Aneurysmal forms of cervical artery dissection. Stroke 2001;32:418‐23. - PubMed
Van Damme 1990 {published data only}
    1. Damme H, Martin D, Stassen M P, Limet R. [Dissections spontanées de la carotide interne. A propos de sept cas avec revue de la littérature]. Journal des Maladies Vasculaires 1990;15:14‐22. - PubMed
Verdalle 2001 {published data only}
    1. Verdale P, Herve S, Kossowski M, Felten D, Courtois A, Garcia D, et al. Spontaneous dissection of the internal carotid artery in its extracranial portion, revealed by hypoglossal paralysis: report of four cases. Annals of Otology, Rhinology and Laryngology 2001;110:794‐8. - PubMed
Vishteh 1998 {published data only}
    1. Vishteh AG, Marciano FF, David CA, Schievink WI, Zabramski JM, Spetzler RF. Long‐term graft patency rates and clinical outcomes after revascularisation for symptomatic traumatic internal carotid artery dissections. Neurosurgery 1998;43:761‐7. - PubMed
Watridge 1989 {published data only}
    1. Watridge CB, Muhlbauer MS, Lowery RD. Traumatic carotid artery dissection: diagnosis and treatment. Journal of Neurosurgery 1989;71:854‐7. - PubMed
Welling 1989 {published data only}
    1. Welling RE, Kremchek TE, Rath RK, Tew JM Jr, Johnson JK. Blunt arterial injuries associated with multiple trauma. Annals of Vascular Surgery 1989;3:345‐50. - PubMed

References to ongoing studies

CADISS {published and unpublished data}
    1. The CADISS Trial Investigators. Antiplatelet therapy vs anticoagulation in cervical artery dissection: rationale and design of the Cervical Artery Dissection in Stroke Study (CADISS). International Journal of Stroke 2007;2(4):292. - PubMed

Additional references

Anderson 1959
    1. Anderson RMD, Schechter MM. A case of spontaneous dissecting aneurysm of the internal carotid artery. Journal of Neurology, Neurosurgery and Psychiatry 1959;22:195‐201. - PMC - PubMed
Anson 1991
    1. Anson J, Crowell RM. Cervicocranial arterial dissection. Neurosurgery 1991;28:89‐96. - PubMed
Beletsky 2003
    1. Beletsky V, Nadareishvili Z, Lynch J, Shuaib A, Woolfenden A, Norris JW. Cervical arterial dissection: time for a therapeutic trial?. Stroke 2003;34:2856‐60. - PubMed
Bogousslavsky 1987a
    1. Bogousslavsky J, Regli F. Ischemic stroke in adults younger than 30 years of age. Archives of Neurology 1987;44:479‐82. - PubMed
CADISP 2009a
    1. Cervical artery dissection and ischemic stroke patients. http://www.cadisp.org/CADISP‐therapeutic aspects: Antiplatelets versus anticoagulation in cervical artery dissection (accessed 22 November 2009).
CADISP 2009b
    1. Debette S, Metso TM, Pezzini A, Engelter ST, Leys D, Lyrer P, et al. CADISP‐genetics: an international project searching for genetic risk factors of cervical artery dissections. International Journal of Stroke 2009;4(3):224‐30. - PubMed
CADISS 2009
    1. The CADISS Trial Investigators. Cervical Artery Dissection in Stroke Study. http://www.dissection.co.uk/ (accessed 16 November 2009) plus personal commuincation with the principal investigator Professor John Norris on 21 November 2009.
Chalmers 1983
    1. Chalmers TC, Celano P, Sacks HS, Smith H. Bias in treatment assignment in controlled clinical trials. New England Journal of Medicine 1983;309:1358‐61. - PubMed
Cimini 2004
    1. Cimini N, D'Andrea P, Gentile M, Berletti R, Ferracci F, Candeago RM, et al. Cervical artery dissection: a 5‐year prospective study in the Belluno district. European Neurology 2004;52(4):207‐10. - PubMed
Debette 2009
    1. Debette S, Leys D. Cervical‐artery dissections: predisposing factors, diagnosis and outcome. Lancet Neurology 2009;8:668–78. - PubMed
Dreier 2004
    1. Dreier JP, Lurtzing F, Kappmeier M, Bohner G, Klingebiel R, Leistner S, et al. Delayed occlusion after internal carotid artery dissection under heparin. Cerebrovascular Diseases 2004;18:296‐303. - PubMed
ECAD 1993
    1. Kraemer G, Ringelstein EB, Thie A. European carotid artery dissection (ECAD) study. Abstract Book, 2nd International Conference on Stroke, Geneva. 1993:17.
Engelter 2007
    1. Engelter ST, Brandt T, Debette S, Caso V, Lichy C, Pezzini A, et al. Antiplatelets versus anticoagulation in cervical artery dissection ‐ a review. Stroke 2007;38:2605‐11. - PubMed
Engelter 2009
    1. Engelter ST, Rutgers MP, Hatz F, Georgiadis D, Fluri F, Sekoranja L, et al. Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke 2009;40:3772‐6. - PubMed
Fluri 2007
    1. Fluri F, Lyrer PA, Steck AJ, Engelter ST. Internal carotid artery dissection with occlusion during heparin therapy. Schweizer Archiv für Neurologie und Psychiatrie 2007;158:331‐3.
Gautier 1989
    1. Gautier JC, Pradat‐Diehl P, Loron P, Lechat P, Lascault G, Juillard JB, et al. [Accidents vasculaires cerebraux des sujets jeunes]. Revista de Neurologia 1989;145(6‐7):437‐42. - PubMed
Giroud 1994
    1. Giroud M, Fayolle H, Andre N. Incidence of internal carotid artery dissection in the community of Dijon. Journal of Neurology, Neurosurgery and Psychiatry 1994;57:1443. - PMC - PubMed
Hart 1983
    1. Hart RG, Easton JD. Dissection of cervical and cerebral arteries. Neurologic Clinics 1983;1(1):155‐82. - PubMed
Hatano 1976
    1. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bulletin of the World Health Organization 1976;54:541–53. - PMC - PubMed
IST 1997
    1. International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both or neither among 19435 patients with acute ischaemic stroke. Lancet 1997;349:1569‐81. - PubMed
Jentzer 1954
    1. Jentzer A. Dissecting aneurysm of the left ICA. Angiology 1954;5:232‐4. - PubMed
Kim 2009
    1. Kim YK, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thrombosis Research 2009;123:810‐21. - PubMed
Leys 1997
    1. Leys D, Lucas Ch, Gobert M, Deklunder G, Pruvo J‐P. Cervical artery dissections. European Neurology 1997;37:3‐12. - PubMed
Leys 2002
    1. Leys D, Bandu L, Henon H, Lucas C, Mounier‐Vehier F, Rondepierre P, et al. Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology 2002;59(1):26‐33. - PubMed
Lyrer 2004
    1. Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Stroke 2004;35(2):613‐4. - PubMed
Lyrer 2005
    1. Lyrer PA. Extracranial arterial dissection: anticoagulation is the treatment of choice: against. Stroke 2005;36(9):2042‐3. - PubMed
Menon 2008a
    1. Menon R, Kerry S, Norris JW, Markus HS. Treatment of cervical artery dissection: a systematic review and meta‐analysis. Journal of Neurology, Neurosurgery and Psychiatry 2008;79:1122‐7. - PubMed
Menon 2008b
    1. Menon RK, Markus HS, Norris JW. Results of a UK questionnaire of diagnosis and treatment in cervical artery dissection. Journal of Neurology, Neurosurgery and Psychiatry 2008;79:612. - PubMed
Norris 2005
    1. Norris JW. Extracranial arterial dissection: anticoagulation is the treatment of choice: for. Stroke 2005;36(9):2041‐2. - PubMed
Rouhart 1993
    1. Rouhart F, Zagnoli F, Goas J‐Y, Mocquard. Arterial ischemic strokes in young adults (40 cases) [Accidents arteriels ischemiques cerebraux de l adulte jeune. 40 cas]. Revista de Neurologia 1993;149(10):547‐53. - PubMed
Sackett 1979
    1. Sackett DL. Bias in analytic research. Journal of Chronic Diseases 1979;32:51‐63. - PubMed
Saver 1992
    1. Saver JL, Easton JD, Hart RG. Dissections and trauma of cervicocerebral arteries. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM editor(s). Stroke. Second Edition. New York: Churchill Livingstone Inc, 1992.
Schievink 1993
    1. Schievink WI, Mokri B, Whisnant JP. Internal carotid artery dissection in a community. Rochester, Minnesota 1987‐1992. Stroke 1993;24:1678‐80. - PubMed
Schievink 2001
    1. Schievink WJ. Spontaneous dissection of the carotid and vertebral arteries. New England Journal of Medicine 2001;344(12):898‐906. - PubMed
Steinke 1996
    1. Steinke W, Schwartz W, Hennerici M. Topography of cerebral infarction associated with carotid artery dissection. Journal of Neurology 1996;243:323‐8. - PubMed
UK‐TIA Study 1988
    1. UK‐TIA Study Group. The UK‐TIA aspirin trial: interim results. BMJ 1988;296:316‐20. - PMC - PubMed

References to other published versions of this review

Lyrer 2003
    1. Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Cochrane Database of Systematic Reviews 2003, Issue 3. [Art. No.: CD000255. DOI: 10.1002/14651858.CD000255] - PubMed

MeSH terms

LinkOut - more resources