Current optimal assessment and management of carotid and vertebral spontaneous and traumatic dissection

Angiology. 2014 Apr;65(4):274-83. doi: 10.1177/0003319712475154. Epub 2013 Feb 11.

Abstract

Dissection of the internal carotid or vertebral artery has been recognized as a cause of stroke in young patients. It is disproportionate in its representation as a cause of stroke in this age group. Intimal tears, intramural hematomas, and dissection aneurysms may be the result of trauma or may occur spontaneously. Spontaneous dissection may be the result of inherent arterial weakness or in association with other predisposing factors. Clinical diagnosis is often difficult, but increased awareness and a range of modern investigations such as computerized tomography or magnetic resonance imaging may aid in diagnosis. Management options include antiplatelet therapy, anticoagulation, thrombolysis, and surgical or endovascular procedures. Prognosis is variable, and dissection may be asymptomatic but may lead to profound neurological deficit and death.

Keywords: carotid artery; dissection aneurysm; spontaneous dissection; traumatic dissection; vertebral artery.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Carotid Artery Injuries / diagnosis
  • Carotid Artery Injuries / etiology
  • Carotid Artery Injuries / mortality
  • Carotid Artery Injuries / therapy*
  • Carotid Artery, Internal, Dissection / diagnosis
  • Carotid Artery, Internal, Dissection / etiology
  • Carotid Artery, Internal, Dissection / mortality
  • Carotid Artery, Internal, Dissection / therapy*
  • Diagnostic Imaging / methods
  • Endovascular Procedures* / adverse effects
  • Fibrinolytic Agents / adverse effects
  • Fibrinolytic Agents / therapeutic use*
  • Genetic Predisposition to Disease
  • Humans
  • Patient Selection
  • Platelet Aggregation Inhibitors / therapeutic use
  • Predictive Value of Tests
  • Risk Factors
  • Stroke / etiology
  • Stroke / therapy
  • Thrombolytic Therapy* / adverse effects
  • Treatment Outcome
  • Vascular System Injuries / diagnosis
  • Vascular System Injuries / etiology
  • Vascular System Injuries / mortality
  • Vascular System Injuries / therapy*
  • Vertebral Artery Dissection / diagnosis
  • Vertebral Artery Dissection / etiology
  • Vertebral Artery Dissection / mortality
  • Vertebral Artery Dissection / therapy*

Substances

  • Anticoagulants
  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors