Management of pediatric craniocervical arterial dissections

Abstract

CCAD is commonly related to trauma and presents with AIS. The majority of patients experience good clinical outcome. Recanalization of initial vessel occlusion occurs in half of cases at 2 years.

How do we Handle Traumatic Pediatric Carotid Artery Dissection?

“…MR Angiography also shows a tapered narrowing or occlusion of the dissected vessel [7]. It is also helpful to determine the age of the thrombosis and therefore a guide to start the anticoagulation treatment or not [7]. Our results also confirmed the high sensitivity of combined MRI and MRA in diagnosing paediatric traumatic CAD.…”

“…In head and neck vasculature; the distal cervical ICA, V1, and V2 segments of the vertebral artery have the highest risk of traumatic dissection, as these are the most mobile segments within the cerebral vascular tree [7]. It is stated that the most vulnerable segment of the carotid artery is the most distal cervical segment before entering the carotid canal at the skull base.…”

“…The mechanism was explained as: the stretching of the artery at the proximal cervical vertebral column with hyperflexion or extension or rotation of the neck causes intimal tears in the artery wall [1,2,6]. Subintimal tear in the arterial wall causes stenosis and thromboembolism; on the other hand, sub adventitial tear causes pseudo aneurysm formation and potential rupture [7]. If either of these tears is able to reconnect to the true lumen, then a double lumen is created in the blood vessel, thereby causing a threat of thromboembolism as well.…”

“…Fat saturated, noncontrast T1-weighted MR images of both head and neck is used to detect the diagnostic intramural hematoma. MR Angiography also shows a tapered narrowing or occlusion of the dissected vessel [7]. It is also helpful to determine the age of the thrombosis and therefore a guide to start the anticoagulation treatment or not [7].…”

“…The first step of the treatment is prevention of thromboembolism via antiplatelet and/or anticoagulation medications. It is recommended that antiplatelet agents can be administered in those patients with asymptomatic dissections, while anticoagulation therapy for those with symptomatic cerebral ischemia related to the CAD [7]. There is no consensus on the duration of the anticoagulation therapy, some administers for three months [7]; some for only 2 weeks [15,16].…”