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Cervical artery dissection (CAD) accounts for 2% of all ischaemic strokes.1 With improved non-invasive neurovascular imaging methods it is now appreciated that carotid and vertebral dissections are much more prevalent than previously believed and account for 25–30% of all ischaemic strokes in young patients aged <50 years. Despite their importance, best therapeutic management remains unclear and is not evidence based.
There are no randomised trials of any treatment regimen in cervical dissection. Following presentation with either local symptoms (pain, headache or Horner’s syndrome) or stroke/TIA there is a risk of stroke, particularly in the first month.2 3 As this is probably thromboembolic, anticoagulation for 3–6 months is often recommended. However, this is not evidence based and there are no data from randomised controlled trials.4 Previous surveys to determine choice of antithrombotic agent in secondary prevention of stroke have shown a bias …