Long-term follow-up after extracranial internal carotid artery dissection

Objective: To evaluate long-term outcome after extracranial internal caroti d artery dissection (elCAD) in consideration of the applied antithrombotic thera py. Material and Methods: Among 33 consecutive elCAD patients initial ly treated either with anticoagulation (n = 25) or with antiplatelets (n = 8), a standardized interview was performed after 28 +/- 22.1 months to anal yze risks and benefits of both agents. Ischemic and hemorrhagic complicatio ns, occurrence of seizure and rates of arterial recanalization were compare d and long-term clinical outcome was assessed using the modified Rankin Sca le (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) r ecurred. In the antiplatelet group, none died and no subsequent ischemic ev ents happened. Hemorrhagic complications were noted in neither treatment gr oup. Functional outcome among anticoagulated patients was BI 92 +/- 21.6 an d mRS 1.48 +/- 1.50, which did not differ from patients initially treated w ith antiplatetets (BI 89 +/- 18.9, mRS 1.50 +/- 1.41, p > 0,05). Four antic oagulated patients developed seizures, compared to 2 patients with antiplat elets (p > 0.05). Arterial recanalization occurred in 16 of 22 anticoagulat ed patients with ultrasound follow-up, compared to 6 of 6 patients with ant iplatelets (p > 0.05), Conclusion: In the absence of iatrogenic side effect s, both anticoagulation and antiplatelets seem to be safe for elCAD. The ra tes for death and stroke were low and outcome ratings did not differ betwee n both agents. These findings may indicate that a controlled randomized tri al comparing anticoagulation and antiplatelets is ethically justified. Copy right (C) 2000 S. Karger AG, Basel.