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(Stroke. 2007;38:1720.)
© 2007 American Heart Association, Inc.

Editorials

Anticoagulation in Cerebral Ischemia Associated With Intracranial Artery Dissections Is Safe, but Is It Enough to Recommend It?

Didier Leys, MD, PhD Stéphanie Debette, MD

From the Department of Neurology, University Hospital of Lille, France.

Correspondence to Prof Didier Leys, Department of Neurology, University Hospital of Lille, rue Emile Laine 59037 Lille, France. E-mail dleys@chru-lille.fr

See related article, pages 1837–1842.

Key Words: dissection • intracranial aneurysm • intracranial disease • intracranial stenosis • subarachnoid hemorrhage

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In most textbooks, intracranial artery dissections are considered rare, difficult to diagnose, and associated with a high risk of subarachnoid hemorrhage (SAH).¹ Three different clinical presentations are described: (1) cerebral ischemia, when the mural hematoma remains subintimal, ie, located between the media and the elastica interna, leading to vessel stenosis or occlusion; (2) SAH when the mural hematoma is subadventitial, ie, located between the media and the adventitia, or transmural, leading to vessel rupture; and (3) acute and isolated headache.² Cerebral ischemia and headache are not specific, because they are also present in most patients with cervical artery dissections. Bleeding is a specificity of intracranial artery dissections. It is explained by structural differences between cervical and intracranial arteries: the latter has no external elastic membrane, and thin muscular and adventitial layers.

There is no clear evidence-based data that anticoagulation, or even antiplatelet therapy, may be beneficial in patients with cervical artery dissection, even if there is a strong rationale for their use, and some indication of a good safety profile. In pure intracranial artery dissections, or in intracranial extensions of cervical artery dissections, the risk of anticoagulation or antiplatelet therapy may be high because of this bleeding risk.

In this issue of Stroke, Metso et al³ describe the largest series of patients with intracranial artery dissections reported up to now. They identified 2 types of intracranial artery dissections: (1) those associated with ischemia, where there is no SAH, no aneurism, a good outcome, and a good safety profile of . . . [Full Text of this Article]

Related Article:

Prognosis and Safety of Anticoagulation in Intracranial Artery Dissections in Adults

Tiina M. Metso, Antti J. Metso, Johanna Helenius, Elena Haapaniemi, Oili Salonen, Matti Porras, Juha Hernesniemi, Markku Kaste, and Turgut Tatlisumak
Stroke 2007 38: 1837-1842. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				M. Arnold, M.-G. Bousser, and R. W. Baumgartner Prognosis and Safety of Anticoagulation in Intracranial Artery Dissections in Adults Stroke, November 1, 2007; 38(11): e140 - e140. [Full Text] [PDF]