Arterial dissection is the underlying stroke mechanism in approximately 2.5% of all strokes and the second leading cause of stroke in patients younger than 45 years of age. Controversy exists regarding the medical management of carotid dissection. Both anticoagulants and antiplatelet agents have been used with no compelling data supporting one therapy over the other. Transcranial Doppler (TCD) emboli monitoring may help in establishing the diagnosis and guide the treatment by measuring the frequency of microembolic signals (MES). We present two cases of carotid dissection where TCD monitoring for MES helped in establishing the diagnosis and proved useful in identifying that standard anticoagulation treatment was not preventing emboli. Both cases were also monitored for emboli count reduction with subsequent antiplatelet therapy.