Dissection Syndromes Guidelines

Updated: Nov 20, 2018
  • Author: Gaurav Gupta, MD, FAANS, FACS; Chief Editor: Helmi L Lutsep, MD  more...
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Guidelines Summary

Extracranial carotid artery dissection

Anticoagulation with intravenous heparin followed by conversion to oral warfarin has been recommended as first-line treatment of patients with extracranial carotid artery dissections to prevent the risk of thromboembolic complications in patients with no contraindications to anticoagulation.

After 6 months of therapy, patients should be reimaged and assessed for arterial recanalization.

Antiplatelet therapy can also be effective in patients with dissections.

Patients with contraindications to anticoagulation should be evaluated for endovascular or surgical treatments.

Extracranial vertebral artery dissection

Similar to extracranial carotid dissections, first-line treatment of extracranial vertebral artery dissections consists of anticoagulation with intravenous heparin followed by transition to oral Coumadin for 3 to 6 months.

Endovascular options include angioplasty and stent placement to recanalize the vertebral artery. Vertebral artery sacrifice through endovascular obliteration or surgical ligation may also be considered in select patients. 

Intracranial arterial dissection

First-line treatment for intracranial arterial dissections is surgical or endovascular intervention. Intracranial dissections are typically associated with subarachnoid hemorrhage and anticoagulation is contraindicated due to high risk of rebleeding.