Anticoagulation vs Antiplatelet Treatment in Patients with Carotid and Vertebral Artery Dissection: A Study of 370 Patients and Literature Review

Daou, Badih; Hammer, Christine; Mouchtouris, Nikolaos; Starke, Robert M.; Koduri, Sravanthi; Yang, Seok-Jo; Jabbour, Pascal; Rosenwasser, Robert H.; Tjoumakaris, Stavropoula

doi:10.1093/neuros/nyw086

Cited by 62 publications

(41 citation statements)

References 28 publications

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“…Stroke rate among BCVI patients has a large variation from 1% up to 53.8%. The majority of these strokes were already in progress when the patient has been admitted to a hospital [5,10,12,17,26,30,39,40,42].…”

Section: This Article Is Part Of the Topical Collection On Brain Traumamentioning

confidence: 99%

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Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

et al. 2020

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Background Blunt cerebrovascular injuries (BCVIs) and cervical spinal injuries (CSIs) are not uncommon injuries in patients with severe head injury and may affect patient recovery. We aimed to assess the independent relationship between BCVI, CSI, and outcome in patients with severe head injury. Methods We identified patients with severe head injury from the Helsinki Trauma Registry treated during 2015-2017 in a large level 1 trauma hospital. We assessed the association between BCVI and SCI using multivariable logistic regression, adjusting for injury severity. Our primary outcome was functional outcome at 6 months, and our secondary outcome was 6-month mortality. Results Of 255 patients with a cervical spine CT, 26 patients (10%) had a CSI, and of 194 patients with cervical CT angiography, 16 patients (8%) had a BCVI. Four of the 16 BCVI patients had a BCVI-related brain infarction, and four of the CSI patients had some form of spinal cord injury. After adjusting for injury severity in multivariable logistic regression analysis, BCVI associated with poor functional outcome (odds ratio [OR] = 6.0, 95% CI [confidence intervals] = 1.4-26.5) and mortality (OR = 7.9, 95% CI 2.0-31.4). We did not find any association between CSI and outcome. Conclusions We found that BCVI with concomitant head injury was an independent predictor of poor outcome in patients with severe head injury, but we found no association between CSI and outcome after severe head injury. Whether the association between BCVI and poor outcome is an indirect marker of a more severe injury or a result of treatment needs further investigations.

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Section: This Article Is Part Of the Topical Collection On Brain Traumamentioning

confidence: 99%

“…Correlating injuries and predisposing conditions to CAI are facial injuries, diffuse axonal injury (DAI), Glasgow Coma Scale (GCS) < 6, and road traffic collisions [34,40]. In terms of patient outcome, CAI seem to be worse than VAI [10].…”

Section: Introductionmentioning

confidence: 99%

Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

et al. 2020

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“…There was also no difference between intracranial and extracranial dissections. The rate of unfavourable clinical outcome (Modified Rankin Score 3–6) did not differ between patients on different courses of treatment 29. Multiple meta-analyses of non-randomised studies of carotid and VADs showed no difference in recurrent stroke, complications or mortality comparing anticoagulation with antiplatelet therapy 30 31.…”

Section: Discussionmentioning

confidence: 92%

Neurogenic pulmonary oedema secondary to vertebral artery dissection while playing tennis

Aljishi¹,

Jayathissa

2018

BMJ Case Reports

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We present a case of a patient who developed vertebral artery dissection (VAD) while playing tennis and presented with neurogenic pulmonary oedema. The case highlights two important points: acute pulmonary oedema as an unusual presenting feature of VAD and VAD, an important cause of stroke in young people, as being associated with playing low-impact sports such as tennis. These associations, independent of each other, are under-recognised and can lead to a delay in diagnosis.

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“…Thus, he was started on anti-platelet therapy with Aspirin 325 mg. Studies have demonstrated similar efficacy between anti-platelet agents and anticoagulants in the treatment of vertebral artery dissections. Although hemorrhagic complications have been reported, the association between these complications and antithrombotic use is not proven [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

C2–C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management

Alexander

Dowlati

McGowan

et al. 2019

Spinal Cord Ser Cases

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Introduction Spinal cord injury is one of the leading causes of paralysis and permanent morbidity. High cervical spine injuries, in particular, have the potential to be fatal and debilitating due to injury to multiple components, including but not limited to, discoligamentous disruption, vascular insult and spinal cord injury. To date, no unifying algorithm exists making it challenging to guide treatment decisions. Case presentation We present the case of a 29-year-old polytrauma patient with an unstable C2-C3 fracture subluxation secondary to hyperextension and rotation injury with complete ligamentous dissociation and vertebral artery dissection after a high-velocity injury. We review the literature on injury patterns, associated complications and neurological outcomes in subaxial cervical spine injuries. Discussion Our patient's injuries had several components including fracture subluxation, ligamentous disruption, central cord syndrome, and vascular insult. The lack of a unifying algorithm to guide treatment decisions highlights the variations in pathology and subsequent limitations in generalizability of current literature. Our patient underwent an open anterior C2-C3 reduction and discectomy with fusion and plating and a subsequent C2-C4 posterior instrumented fusion. The patient regained some motor function postoperatively and through rehabilitation. Careful consideration of multiple components is crucial when treating subaxial spine injuries.

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Anticoagulation vs Antiplatelet Treatment in Patients with Carotid and Vertebral Artery Dissection: A Study of 370 Patients and Literature Review

Abstract: The rate of new or recurrent events is similar with antiplatelet and anticoagulation treatment in treating intracranial and extracranial carotid and vertebral artery dissection.

Cited by 62 publications

References 28 publications

Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

Neurogenic pulmonary oedema secondary to vertebral artery dissection while playing tennis

C2–C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management

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