What is the prevalence of vertebral artery dissection?

Prevalence of Vertebral Artery Dissection

The annual incidence of spontaneous vertebral artery dissection is 1 to 1.5 per 100,000 population, making it less common than carotid dissection but a critical cause of stroke in younger patients. 1

Epidemiological Context

Incidence rates:

• Spontaneous vertebral artery dissection occurs at 1 to 1.5 per 100,000 annually 1
• Traumatic dissection occurs in approximately 1% of all patients with blunt injury mechanisms 1
• The incidence has not been as well defined as carotid dissection, and posterior circulation strokes may be underestimated due to difficulty visualizing vertebral artery origins by ultrasound 2

Contribution to stroke burden:

• Vertebral artery dissection accounts for approximately 2% of all ischemic strokes in the general population 2, 1
• However, it represents approximately 10-15% to 20% of ischemic strokes in patients under 45 years of age 3, 1
• This makes it a leading cause of stroke in young and otherwise healthy patients 4

Clinical Significance

The condition is frequently initially unrecognized, particularly in traumatic cases, which underscores the importance of maintaining high clinical suspicion. 1

• After warning symptoms occur (headache, neck pain, vertigo), cerebral or retinal ischemia develops in 50% to 95% of cases 2, 5
• The V4 (intracranial) segment is the most prevalent site for intracranial dissection 6
• Vertebral artery dissection can present either as ischemia or as subarachnoid hemorrhage, with ruptured dissections carrying considerably higher mortality rates 6

Comparison to Carotid Dissection

• Spontaneous carotid artery dissection has a higher annual incidence of 2.5 to 3 per 100,000, making vertebral artery dissection approximately half as common 1
• Symptomatic obstructive disease of the vertebral arteries is less common than carotid stenosis overall 2