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(Stroke. 2003;34:2856.)
© 2003 American Heart Association, Inc.

Original Contributions

Cervical Arterial Dissection

Time for a Therapeutic Trial?

Vadim Beletsky, MD, PhD; Zurab Nadareishvili, MD, PhD; John Lynch, DO, MPH; Ashfaq Shuaib, MD; Andrew Woolfenden, MD John W. Norris, MD for the Canadian Stroke Consortium

From the University of Western Ontario, London, Ontario, Canada (V.B.); University of Toronto, Toronto, Ontario, Canada (Z.N., J.W.N.); National Institutes of Health, Bethesda, Md (J.L.); University of Alberta, Edmonton, Alberta, Canada (A.S.); and University of British Columbia, Vancouver, BC, Canada (A.W.).

Correspondence to Vadim Beletsky, MD, PhD, Department of Clinical Neurological Sciences, University Hospital, Room 7GE5, 339 Windermere Rd, London, Ontario, Canada N6A 5A5. E-mail vados{at}imaging.robarts.ca

Background and Purpose— Cervical arterial dissection is a major cause of stroke in young adults, yet despite standard treatment with anticoagulants or antiplatelet drugs, its management remains uncertain. The goal of this study was to assess the natural history of the disorder and to decide on the feasibility of a therapeutic trial.

Methods— Collaborating members of the Canadian Stroke Consortium prospectively enrolled consecutively referred patients with angiographically proven acute vertebral or carotid arterial dissection. Data recorded included clinical and radiological details, recurrence of ischemic cerebral events, and medical or surgical treatment.

Results— Of 116 patients, 67 had vertebral and 49 had carotid dissections, with no difference in age or sex. In 68 (59%), trauma occurred at the time of dissection. During the course of a 1-year follow-up, at least 17 patients (15%) had recurrent transient ischemic attacks, stroke, or death, mainly in the weeks immediately after the dissection. In 105 patients with complete follow-up, the event rate in those treated with anticoagulants was 8.3% and in those treated with aspirin was 12.4%, a nonsignificant difference of 4.1%. Using these data, we calculate that for a 2-arm trial (aspirin versus anticoagulants) with 80% power and 5% significance, 913 patients are needed in each group.

Conclusions— From our data indicating an initial relatively high recurrence rate, a multicenter trial of anticoagulants versus aspirin involving a total of 2000 patients is feasible.

Key Words: dissection • randomized controlled trials • stroke

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