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Treatment of arterial dissection is tailored to each child depending on the location of the blood vessel tear and its severity.
If the dissection is in blood vessels in the neck rather than the head (known as extracranial dissection) and is relatively small, we usually place children on anticoagulant (blood-thinning) drugs for three to six months, or sometimes longer. This decreases the chance of a clot forming and then flowing into the brain. We do repeat imaging to make sure that the vessel has healed before stopping the medication.
If the vessel tear is too severe to heal on its own, we have two options: we can place a stent (a thin, flexible metal mesh tube) inside the artery to create a new, stable inside surface, or we can close the injured artery to prevent it from becoming a source of clots that might flow into the brain. If an artery is to be closed, we perform extensive testing (known as balloon test occlusion) beforehand, to ensure that there will be enough blood supply from neighboring bridging arteries.
When the dissection is in vessels within the brain, the artery is usually too injured to remain viable. In this case, the child is at greater risk for a brain hemorrhage than for a blood clot. Thus, treatment is usually aimed at closing the torn vessels before they cause bleeding, which can be done either surgically or through catheter-based endovascular techniques.
If healthy nearby arteries cannot supply enough blood in place of the dissected arteries, a direct arterial bypass may be necessary as a first step. The most common form of this operation is known as a superficial temporal to middle cerebral artery anastomosis or STA-MCA bypass, in which neurosurgeons join a blood vessel from the child's scalp directly to a vessel in the brain to improve blood flow.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”