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Dissection of the carotid and the vertebral artery

Last updated: November 23, 2020

Summary

Carotid or vertebral artery dissection describes the separation of the tunica media and tunica intima of a vessel. This can lead to thrombosis of the false lumen, which can, in turn, lead to stenoses or embolisms with the risk of stroke. Dissections of the carotid and vertebral artery primarily affect young adults and may occur spontaneously or as a result of a major trauma (e.g., car accidents). The initial symptoms are usually headaches (temporal and occipital for carotid and vertebral artery dissection respectively), which may be followed by features of ischemia (e.g., stroke) a few hours or days later. Duplex ultrasonography may provide a rapid diagnosis, but definitive diagnosis requires CT angiography or MR angiography. Treatment is primarily conservative and involves blood thinners, anticoagulants, and antiplatelet therapy. Severe cases may require surgery.

Epidemiology

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[1]

Clinical features

Dissection of the carotid artery

Dissection of the vertebral artery

Carotid or vertebral artery dissection is the separation of the tunica media and tunica intima of a vessel. This can lead to thrombosis of the false lumen, which can, in turn, lead to stenoses or embolisms with the risk of stroke!

References:[1][2][3]

Diagnostics

Baseline monitoring parameters (e.g., INR, PT, aPPT) should be performed before administering anticoagulant therapy!
References:[1][2]

Treatment

Asymptomatic pseudoaneurysms do not usually require treatment and most dissections heal spontaneously!
References:[2][4]

References

  1. Liebeskind DS. Spontaneous cerebral and cervical artery dissection: Clinical features and diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/spontaneous-cerebral-and-cervical-artery-dissection-clinical-features-and-diagnosis.Last updated: September 28, 2016. Accessed: February 15, 2017.
  2. Lang ES. Vertebral Artery Dissection. Vertebral Artery Dissection. New York, NY: WebMD. http://emedicine.medscape.com/article/761451-overview. Updated: January 18, 2017. Accessed: February 15, 2017.
  3. Bardorf CM. Horner Syndrome. In: Ing E, Horner Syndrome. New York, NY: WebMD. http://emedicine.medscape.com/article/1220091-overview#showall. Updated: May 17, 2016. Accessed: December 12, 2016.
  4. Liebeskind DS. Spontaneous cerebral and cervical artery dissection: Treatment and prognosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/spontaneous-cerebral-and-cervical-artery-dissection-treatment-and-prognosis.Last updated: September 16, 2015. Accessed: March 2, 2017.