Cervical Artery Dissection in Stroke Study (CADISS)
Dissection of the carotid and vertebral arteries is a major cause of stroke in persons under 50 years of age, mainly due to embolism from the clot sealing the tear.
At present physicians treat these patients with anticoagulants or antiplatelet drugs to prevent further stroke, but neither therapy is evidence- based. Anticoagulants may be powerful anti-embolic agents but are also more hazardous than aspirin, and potentially could encourage further dissection. Most published studies are flawed by retrospective data, with no reference to the number of patients in the original study cohort and do not include the critical principles of randomisation and ‘blinding’ of outcomes.
The Cervical Artery Dissection in Stroke Study (CADISS) is a randomised multicentre prospective study comparing antiplatelet therapy with anticoagulation for patients with carotid and vertebral artery dissection. Randomisation must be within seven days of onset of symptoms.
The aim of the study is to determine the feasibility of a clinical trial comparing antiplatelet therapy with anticoagulant therapy in the acute treatment of patients with cervical artery dissection.
Specifically to address whether:
- There are sufficient clinical endpoints to provide the power to determine treatment effect.
- Adequate number of patients can be recruited.
The feasibility study was conducted in the UK and was also extended to Australia to meet our recruitment target.
Recruitment of our target of 250 patients was achieved in June 2013 and follow-up completed in June 2014.
The results were published in the Lancet Neurology (2015;14:361-7) and discussed in an accompanying editorial (Kasner SE. CADISS: a feasibility trial that answered its question. Lancet Neurol. 2015;14:342-3).