2017 年 29 巻 2 号 p. 5-9
Cerebral artery dissection is common in ischemic stroke in young adults. In Japan, approximately 1.2% of all ischemic strokes are caused by cerebral artery dissection. In patients aged ≤50 years, cerebral artery dissection accounts for 2.3%-3.8% of all ischemic strokes. Cerebral artery dissection in Japan typically involves the intracranial vertebral artery as opposed to the extracranial carotid artery, which is commonly involved in Western countries. Extracranial artery dissection can theoretically cause either hemodynamic or thromboembolic ischemic stroke. The rate of ischemic recurrence has been estimated to be between 0% and 13.3% at 1 year after the dissection. Furthermore, recurrent ischemic events usually occur between 1 and 2 weeks after the dissection. The usual regimen includes immediate heparin therapy with long-term warfarin between 3 and 6 months; further management is decided based on the results of vascular imaging. However, in our case, recurrent ischemic stroke occurred 15 years after the right extracranial vertebral artery dissection. Therefore, the pathology and etiology of the dissection should be considered for each case. Despite the onset period of 3-6 months, we should decide on further management based on vascular imaging findings.