From the Guidelines
Carotid artery dissection is a high-risk condition that can lead to ischemic stroke, and its high-risk features include connective tissue disorders, trauma, and certain underlying medical conditions.
High-Risk Features of Carotid Artery Dissection
The following are considered high-risk features of carotid artery dissection:
- Connective tissue disorders: Such as fibromuscular dysplasia (FMD), Marfan syndrome, Ehlers-Danlos syndrome (type IV), osteogenesis imperfecta, and genetic conditions that affect collagen formation 1.
- Trauma: Penetrating trauma, amphetamine abuse, and sudden or excessive neck movement, such as chiropractic manipulation or hyperflexion/hyperextension of the neck 1.
- Underlying medical conditions: Bicuspid aortic valve, although carotid dissection is observed in only 1% to 5% of patients with this disorder 1.
- Age: Carotid dissection may account for 10% to 15% of ischemic strokes in younger patients 1.
Clinical Presentation
The clinical presentation of carotid artery dissection can be variable, but common features include:
- Pain on one side of the head or neck: Accompanied by Horner syndrome, which includes asymmetrical ptosis, meiosis, and anhidrosis 1.
- Cerebral or retinal ischemia: Develops in 50% to 95% of cases of carotid artery dissection after the initial warning symptoms 1.
Diagnosis and Treatment
Diagnosis begins with clinical examination and brain imaging, followed by vascular imaging when an ischemic cause is suspected 1. Treatment is usually conservative, involving anticoagulation with heparin followed by warfarin, although there have been no placebo-controlled trials of anticoagulant or antiplatelet agents or randomized trials comparing anticoagulant and antiplatelet therapy 1.
From the Research
High-Risk Features of Carotid Artery Dissection
The high-risk features of carotid artery dissection include:
- Intimal tear or rupture of the vasa vasorum, leading to an intramural hematoma 2
- Trauma or spontaneous occurrence, with environmental and intrinsic factors contributing to the dissection 2
- Presence of local pain, facial paralysis, and pupillary defects 3
- History of neck trauma, recent infection, family history, smoking, hypertension, oral contraceptives, migraine headaches, and connective tissue disease 3
- Risk of embolic ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage 4
Imaging Characteristics
Imaging characteristics of carotid dissection include:
- "Double lumen" sign comprised of the true vessel lumen and the false lumen created by the tear 4
- Intramural hematoma detectable by susceptibility-weighted imaging (SWI) 4
- Multisection motion-sensitized driven equilibrium (MSDE) for 3D T1- or T2*-weighted images 4
Clinical Presentations
Clinical presentations of carotid artery dissection include: