Rivaroxaban in cervical and “cervico-cerebral” artery dissections: a new therapeutic option?
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.
KeywordsCervical and cervico-cerebral artery dissections Stroke Transcranial color Doppler Neurosonology DOACs Rivaroxaban
Compliance with ethical standards
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 7.Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff E, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, Society for Vascular Surgery, American Academy of Neurology and Society of Cardiovascular Computed Tomography (2011) ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. Stroke 42:e420–e463Google Scholar
- 10.Daou B, Hammer C, Mouchtouris N, Starke RM, Koduri S, Yang S, Jannour P, Rosenwasser R, Tjoumakaris S (2017) Anticoagulation vs antiplatelet treatment in patients with carotid and vertebral artery dissection: a study of 370 patients and literature review. Neurosurgery 80(3):368–379CrossRefGoogle Scholar
- 11.Lyrer P, Engelter S (2010) Antithrombotic drugs for carotid artery dissection. Cochrane Database Syst Rev 10:CD000255Google Scholar
- 23.Malferrari G, Accorsi F, Sanguigni S (2010) Neurosonological examination in acute stroke patients. A pocket guide. La Dotta, Modena (ed)Google Scholar
- 24.Malferrari G, Pulito G, Pizzini AM, Carraro N, Meneghetti G, Sanzaro E, Prati P, Siniscalchi A, Monaco D (2018) MicroV technology to improve transcranial color coded Doppler examinations. J Neuroimaging 28(4):350–358Google Scholar
- 25.Clevert DA, Jung EM, Johnson T, Kubale R, Rupp N, Schoenberg SO, Reiser M (2007) Cervical artery dissection: improved diagnosis by B-Flow ultrasound. Clin Hemorheol Microcirc 36:141–153Google Scholar
- 26.Gottesman RF, Sharma P, Robinson KA, Arnan M, Tsui M, Saber-Tehrani A, Newman Toker DE (2012) Imaging characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist 18(5):225–260Google Scholar