Department of Neurology Unit, Azienda USL-IRCCS, Reggio Emilia, RE, Italy.
Department of Neuroscience, St. Agostino Estense Hospital, University of Modena and Reggio Emilia, Modena, Italy.
Neurol Sci. 2019 Aug;40(8):1591-1596. doi: 10.1007/s10072-019-03882-8. Epub 2019 Apr 12.
Antiplatelet agents and vitamin K antagonists (VKA) are usually used in the treatment of cervical (carotid or vertebral) artery dissections (CADs); however, data about the use of direct oral anticoagulants (DOACs) in these conditions are very limited. DOACs have proven to be effective in stroke reduction in non-valvular atrial fibrillation and, when possible, they are preferred to warfarin because of their better safety profile. We describe four cases of CADs and, firstly in literature, cervico-cerebral (CCADs) in young patients (average age of 42 years) treated with rivaroxaban 20 mg daily. Three of these four dissections had affected the vertebral artery (condition with an unfavorable prognosis and more often complicated by subarachnoid hemorrhages), and the other one was a carotid dissection at the extra-intracranial passage. All patients were followed clinically and with serial neurosonological examinations at 1, 3, and 6 months and with magnetic resonance angiography (MRA) at 6 months. All patients presented a good outcome with vascular recanalization without stroke recurrence or bleedings, even in patients with intracranial vertebral artery involvement. DOACs could be an alternative in young patients with CADs and their use could be considered in intracranial artery dissections too.
抗血小板药物和维生素 K 拮抗剂（VKA）通常用于治疗颈（颈内或椎动脉）动脉夹层（CAD）；然而，关于这些情况下使用直接口服抗凝剂（DOAC）的数据非常有限。DOAC 已被证明在非瓣膜性心房颤动中降低中风的有效性，并且在可能的情况下，由于其更好的安全性，它们优于华法林。我们描述了 4 例 CAD 病例，首先在文献中，年轻患者（平均年龄 42 岁）接受每日 20 毫克利伐沙班治疗颈-脑（CCAD）。这 4 例夹层中有 3 例影响椎动脉（预后不佳，更常并发蛛网膜下腔出血），另 1 例为颅外-颅内段颈动脉夹层。所有患者均进行临床随访，并在 1、3 和 6 个月进行连续神经超声检查，在 6 个月进行磁共振血管造影（MRA）检查。所有患者血管再通，无中风复发或出血，即使是颅内椎动脉受累的患者，预后良好。DOAC 可能是 CAD 年轻患者的一种替代治疗方法，也可考虑在颅内动脉夹层中使用。
