Incidence Rate of Vertebral Artery Dissection
The incidence of vertebral artery dissection has not been well defined, but the best available evidence suggests an annual incidence of approximately 1.0-2.0 per 100,000 population, with recent data showing a dramatic increase to 2.01 per 100,000 person-years and potentially higher rates when including all cervical artery dissections. 1, 2
Current Epidemiological Data
The 2011 ASA/ACCF/AHA guidelines explicitly state that "the incidence of vertebral artery dissection has not been well defined" 1. However, multiple population-based studies have since provided more concrete estimates:
Historical Baseline Rates
- Vertebral artery dissection alone: 0.97-1.87 per 100,000 per year 3, 4, 5
- All spontaneous cervical artery dissections: 2.6 per 100,000 per year (2006 estimate) 3
Recent Trends Show Dramatic Increases
The most recent and highest-quality population-based study from 2024 reveals a striking upward trend 2:
- Overall cervical artery dissection incidence: 4.69 per 100,000 person-years (2002-2020)
- Vertebral artery dissection specifically: 2.01 per 100,000 person-years
- Temporal trend: Incidence increased nearly 4-fold from 2.30 per 100,000 (2002-2006) to 8.93 per 100,000 (2017-2020)
- Sex-specific finding: Female incidence rose over 12-fold during this period
Important Context and Caveats
Why the Increase?
This dramatic rise likely reflects improved detection rather than true increased disease occurrence 2. The widespread adoption of noninvasive vascular imaging (CTA and MRA) has substantially improved diagnostic capabilities, capturing cases that would have been missed in earlier eras.
Comparison to Carotid Dissection
Vertebral artery dissection occurs approximately half as frequently as internal carotid artery dissection 3. However, in more recent time periods, the detection rates have become nearly equivalent, again suggesting improved diagnostic recognition 3.
Special Populations
- Younger patients: Cervical artery dissections (including vertebral) account for approximately 20% of ischemic strokes in patients under 45 years of age 4
- Post-manipulation: The incidence of vertebral artery dissection or occlusion attributable to cervical manipulation in patients ≤45 years is approximately 1.3 per 100,000 within 1 week of manipulative therapy 1
Geographic and Demographic Variations
Recent U.S. data (2005-2019) shows particularly high increases in racial minorities, with the overall cervical artery dissection incidence rising from 10.7 to 45.6 cases per million population 6. This represents an average annual percent change of 10.21%, with especially pronounced increases in Black and Hispanic populations.
Clinical Significance
The true population incidence remains uncertain due to:
- Asymptomatic cases that never present clinically
- Variable access to advanced imaging across different healthcare settings
- Evolving diagnostic criteria and awareness among clinicians
- Potential underdiagnosis in resource-limited settings
The best current estimate for clinical practice purposes is approximately 1-2 per 100,000 population annually for vertebral artery dissection specifically, with recognition that this number is rising due to improved detection methods rather than true increased disease burden.