Mechanism of Stroke with Extracranial Artery Dissection

Primary Pathophysiological Mechanism

The American Heart Association/American Stroke Association states that artery-to-artery embolism is the dominant mechanism of stroke with extracranial artery dissection, accounting for the majority of ischemic events, and recommends using antithrombotic agents to decrease stroke risk in patients with this condition 1, 2, 3, 4
Artery-to-artery embolism is the most common mechanism of stroke with extracranial artery dissection, resulting from an intraluminal thrombus that forms at the site of the dissected vessel, and is the rationale for using antithrombotic agents to decrease stroke risk in patients with extracranial artery dissection 1, 2, 3, 4

The embolic mechanism explains why antithrombotic therapy is the cornerstone of treatment for patients with extracranial artery dissection, as the primary threat to the brain comes from thromboembolic material rather than the dissection itself 1, 2, 3, 4
Early antithrombotic therapy is recommended because the risk of stroke is greatest in the first few days after the initial vascular injury in patients with extracranial artery dissection 5
Dissecting aneurysms can serve as an additional source of thrombus formation and embolization in patients with extracranial artery dissection, highlighting the importance of early diagnosis and treatment 5