Long-term follow-up after extracranial internal carotid artery dissection.
OBJECTIVE
To evaluate long-term outcome after extracranial internal carotid artery dissection (eICAD) in consideration of the applied antithrombotic therapy.


METHODS
Among 33 consecutive eICAD patients initially treated either with anticoagulation (n = 25) or with antiplatelets (n = 8), a standardized interview was performed after 28 +/- 22.1 months to analyze risks and benefits of both agents. Ischemic and hemorrhagic complications, occurrence of seizure and rates of arterial recanalization were compared and long-term clinical outcome was assessed using the modified Rankin Scale (mRS) and Barthel Index (BI).


RESULTS
Among anticoagulated patients, 1 died due to brain herniation. In 3 patients stroke (n = 2) or TIA (n = 1) recurred. In the antiplatelet group, none died and no subsequent ischemic events happened. Hemorrhagic complications were noted in neither treatment group. Functional outcome among anticoagulated patients was BI 92 +/- 21.6 and mRS 1.48 +/- 1.50, which did not differ from patients initially treated with antiplatelets (BI 89 +/- 18.9, mRS 1.50 +/- 1.41, p > 0.05). Four anticoagulated patients developed seizures, compared to 2 patients with antiplatelets (p > 0.05). Arterial recanalization occurred in 16 of 22 antico- agulated patients with ultrasound follow-up, compared to 6 of 6 patients with antiplatelets (p > 0.05).


CONCLUSIONS
In the absence of iatrogenic side effects, both anticoagulation and antiplatelets seem to be safe for eICAD. The rates for death and stroke were low and outcome ratings did not differ between both agents. These findings may indicate that a controlled randomized trial comparing anticoagulation and antiplatelets is ethically justified.
Engelter
S T
ST
Department of Neurology, University Hospital Basel, Switzerland. STEngelter@compuserve.com
Lyrer
P A
PA
Kirsch
E C
EC
Steck
A J
AJ
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002545:Brain Ischemia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D002343:Carotid Artery, Internal / Q000187:drug effects / Q000473:pathology*; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D020127:Recovery of Function / Q000187:drug effects; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors