What is the medical care for vertebral artery dissection (VAD)?

Updated: Feb 21, 2019
  • Author: Eddy S Lang, MDCM, CCFP(EM), CSPQ; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Findings from the Cervical Artery Dissection in Stroke Study (CADISS) trial, the only randomized trial to examine antiplatelets versus anticoagulants in the treatment of extracranial carotid and vertebral artery dissections (VADs) were published in 2015, in which no differences in outcomes between groups receiving antiplatelets versus anticoagulants were found. [40] Two hundred and fifty patients (118 with carotid artery dissection [CAD]; 132 with VAD) were randomized to either antiplatelet therapy or anticoagulant therapy and followed out to a 3 month period. Recurrent stroke was rare within this time frame (2%). [40] There was a very low incidence of postdissection adverse effects in both groups, meaning randomized studies examining treatment effects on secondary outcomes will be lacking.

Similar findings to those discussed above have been reported in previous meta-analyses examining antithrombotic treatments for CAD and VADs. [41, 42]

At this time, therefore, it would be reasonable to treat patients who are not candidates for surgical therapy, to receive either antiplatelet therapy (aspirin, with or without clopidogrel) or anticoagulant therapy (warfarin, with or without heparin).


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