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Cervical (Carotid and Vertebral) Artery Dissection

  • Vishal B. Jani
  • Richard D. Fessler
Chapter

Abstract

Cervical artery dissection was first reported in an autopsy report by Fred Thomas in 1947 (Schievink, New Engl J Med 344:898–906, 2001). Cervical artery dissection (CAD) is a general term including both carotid and vertebral artery dissections. A CAD occurs when there is a tear in the intimal layer of a carotid or vertebral artery that leads to the development of an intramural hematoma. The hematoma can cause stenosis, occlusion, or aneurysmal dilation. Early detection is of paramount importance as the risk of recurrent stroke is highest during the first month following a CAD. CAD is now recognized as one of the most common causes of stroke in the young, accounting for up to 30% of stroke cases (Ducrocq et al., Revue Neurol 155(8): 575–82, 1999). The present chapter will focus on the clinical features, diagnosis, and available treatment options for spontaneous (non-traumatic) CAD.

Keywords

Carotid dissection Vertebral dissection Horner syndrome Traumatic dissection Spontaneous dissection Anticoagulation 

References

  1. 1.
    Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001;344(12):898–906.  https://doi.org/10.1056/NEJM200103223441206.CrossRefPubMedGoogle Scholar
  2. 2.
    Ducrocq X, Lacour JC, Debouverie M, Bracard S, Girard F, Weber M. Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years. Revue Neurol. 1999;155(8):575–82. http://www.ncbi.nlm.nih.gov/pubmed/10486847.Google Scholar
  3. 3.
    Giroud M, Fayolle H, André N, Dumas R, Becker F, Martin D, et al. Incidence of internal carotid artery dissection in the community of Dijon. J Neurol Neurosurg Psychiat. 1994;57(11):1443. http://www.ncbi.nlm.nih.gov/pubmed/7964839.CrossRefPubMedGoogle Scholar
  4. 4.
    Lee VH, Brown RD, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study. Neurology. 2006;67(10):1809–12.  https://doi.org/10.1212/01.wnl.0000244486.30455.71.CrossRefPubMedGoogle Scholar
  5. 5.
    Arnold M, Kappeler L, Georgiadis D, Berthet K, Keserue B, Bousser MG, Baumgartner RW. Gender differences in spontaneous cervical artery dissection. Neurology. 2006;67(6):1050–2.  https://doi.org/10.1212/01.wnl.0000237341.30854.6a.CrossRefPubMedGoogle Scholar
  6. 6.
    Touzé E, Gauvrit J-Y, Moulin T, Meder J-F, Bracard S, Mas J-L, Multicenter Survey on Natural History of Cervical Artery Dissection. Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. Neurology. 2003;61(10):1347–51. http://www.ncbi.nlm.nih.gov/pubmed/14638953.CrossRefPubMedGoogle Scholar
  7. 7.
    Thanvi B, Munshi SK, Dawson SL, Robinson TG. Carotid and vertebral artery dissection syndromes. Postgrad Med J. 2005;81(956):383–8.  https://doi.org/10.1136/pgmj.2003.016774.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Debette S, Metso T, Pezzini A, Abboud S, Metso A, Leys D, Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) Group, et al. Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation. 2011;123(14):1537–44.  https://doi.org/10.1161/CIRCULATIONAHA.110.000125.CrossRefPubMedGoogle Scholar
  9. 9.
    Pezzini A, Granella F, Grassi M, Bertolino C, Del Zotto E, Immovilli P, et al. History of migraine and the risk of spontaneous cervical artery dissection. Cephalalgia. 2005;25(8):575–80.  https://doi.org/10.1111/j.1468-2982.2005.00919.x.CrossRefPubMedGoogle Scholar
  10. 10.
    Tzourio C, Benslamia L, Guillon B, Aïdi S, Bertrand M, Berthet K, Bousser MG. Migraine and the risk of cervical artery dissection: a case-control study. Neurology. 2002;59(3):435–7. http://www.ncbi.nlm.nih.gov/pubmed/12177380.CrossRefPubMedGoogle Scholar
  11. 11.
    Gallai V, Caso V, Paciaroni M, Cardaioli G, Arning E, Bottiglieri T, Parnetti L. Mild hyperhomocyst(e)inemia: a possible risk factor for cervical artery dissection. Stroke. 2001;32(3):714–8. http://www.ncbi.nlm.nih.gov/pubmed/11239192.CrossRefPubMedGoogle Scholar
  12. 12.
    Grau AJ, Buggle F, Rubinstein SM, Peerdeman S, van Tulder M, Haldeman S. A systemic review of the risk factors for cervical artery dissection. Stroke. 2005;36(11):2340.  https://doi.org/10.1161/01.STR.0000185695.67188.f7.CrossRefPubMedGoogle Scholar
  13. 13.
    Grau AJ, Brandt T, Buggle F, Orberk E, Mytilineos J, Werle E, et al. Association of cervical artery dissection with recent infection. Arch Neurol. 1999;56(7):851–6. http://www.ncbi.nlm.nih.gov/pubmed/10404987.CrossRefPubMedGoogle Scholar
  14. 14.
    Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009;8(7):668–78.  https://doi.org/10.1016/S1474-4422(09)70084-5.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Arauz A, Hoyos L, Cantú C, Jara A, Martínez L, García I, et al. Mild Hyperhomocysteinemia and low folate concentrations as risk factors for cervical arterial dissection. Cerebrovasc Dis. 2007;24(2–3):210–4.  https://doi.org/10.1159/000104479.CrossRefPubMedGoogle Scholar
  16. 16.
    Longoni M, Grond-Ginsbach C, Grau AJ, Genius J, Debette S, Schwaninger M, et al. The ICAM-1 E469K gene polymorphism is a risk factor for spontaneous cervical artery dissection. Neurology. 2006;66(8):1273–5.  https://doi.org/10.1212/01.wnl.0000208411.01172.0b.CrossRefPubMedGoogle Scholar
  17. 17.
    Pezzini A, Del Zotto E, Archetti S, Negrini R, Bani P, Albertini A, et al. Plasma homocysteine concentration, C677T MTHFR genotype, and 844ins68bp CBS genotype in young adults with spontaneous cervical artery dissection and atherothrombotic stroke. Stroke. 2002;33(3):664–9. http://www.ncbi.nlm.nih.gov/pubmed/11872884.CrossRefPubMedGoogle Scholar
  18. 18.
    von Pein F, Välkkilä M, Schwarz R, Morcher M, Klima B, Grau A, et al. Analysis of the COL3A1 gene in patients with spontaneous cervical artery dissections. J Neurol. 2002;249(7):862–6.  https://doi.org/10.1007/s00415-002-0745-x.CrossRefGoogle Scholar
  19. 19.
    Schievink WI, Mokri B, Piepgras DG, Kuiper JD. Recurrent spontaneous arterial dissections: risk in familial versus nonfamilial disease. Stroke. 1996;27(4):622–4. http://www.ncbi.nlm.nih.gov/pubmed/8614918.CrossRefPubMedGoogle Scholar
  20. 20.
    Kim Y-K, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res. 2009;123(6):810–21.  https://doi.org/10.1016/j.thromres.2009.01.013.CrossRefPubMedGoogle Scholar
  21. 21.
    Brandt T, Orberk E, Weber R, Werner I, Busse O, Müller BT, et al. Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology. 2001;57(1):24–30. http://www.ncbi.nlm.nih.gov/pubmed/11445623.CrossRefPubMedGoogle Scholar
  22. 22.
    Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the Management of Patients with extracranial carotid and vertebral artery disease: executive summary. J Am Coll Cardiol. 2011;57(8):1002–44.  https://doi.org/10.1016/j.jacc.2010.11.005.CrossRefPubMedGoogle Scholar
  23. 23.
    Djouhri H, Guillon B, Brunereau L, Lévy C, Bousson V, Biousse V, et al. MR angiography for the long-term follow-up of dissecting aneurysms of the extracranial internal carotid artery. AJR Am J Roentgenol. 2000;174(4):1137–40.  https://doi.org/10.2214/ajr.174.4.1741137.CrossRefPubMedGoogle Scholar
  24. 24.
    Kasner SE, Hankins LL, Bratina P, Morgenstern LB. Magnetic resonance angiography demonstrates vascular healing of carotid and vertebral artery dissections. Stroke. 1997;28(10):1993–7. http://www.ncbi.nlm.nih.gov/pubmed/9341709.CrossRefPubMedGoogle Scholar
  25. 25.
    Kirsch E, Kaim A, Engelter S, Lyrer P, Stock KW, Bongartz G, Radü EW. MR angiography in internal carotid artery dissection: improvement of diagnosis by selective demonstration of the intramural haematoma. Neuroradiology. 1998;40(11):704–9. http://www.ncbi.nlm.nih.gov/pubmed/9860118.CrossRefPubMedGoogle Scholar
  26. 26.
    Leclerc X, Lucas C, Godefroy O, Nicol L, Moretti A, Leys D, Pruvo JP. Preliminary experience using contrast-enhanced MR angiography to assess vertebral artery structure for the follow-up of suspected dissection. AJNR Am J Neuroradiol. 1999;20(8):1482–90. http://www.ncbi.nlm.nih.gov/pubmed/10512235.PubMedGoogle Scholar
  27. 27.
    Provenzale JM. MRI and MRA for evaluation of dissection of craniocerebral arteries: lessons from the medical literature. Emerg Radiol. 2009;16(3):185–93.  https://doi.org/10.1007/s10140-008-0770-x.CrossRefPubMedGoogle Scholar
  28. 28.
    Lisovoski F, Rousseaux P. Cerebral infarction in young people. A study of 148 patients with early cerebral angiography. J Neurol Neurosurg Psychiatry. 1991;54(7):576–9. http://www.ncbi.nlm.nih.gov/pubmed/1895119.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Provenzale JM. Dissection of the internal carotid and vertebral arteries: imaging features. Am J Roentgenol. 1995;165(5):1099–104.  https://doi.org/10.2214/ajr.165.5.7572483.CrossRefGoogle Scholar
  30. 30.
    Shimoji T, Bando K, Nakajima K, Ito K. Dissecting aneurysm of the vertebral artery. J Neurosurg. 1984;61(6):1038–46.  https://doi.org/10.3171/jns.1984.61.6.1038.CrossRefPubMedGoogle Scholar
  31. 31.
    Clark W, Papamitsakis NIH. Stroke: pathophysiology, diagnosis, and management, 3rd ed. J Vasc Surg. 1999;30(6):769–86.  https://doi.org/10.1016/S0741-5214(99)70063-7.CrossRefGoogle Scholar
  32. 32.
    Stapf C, Elkind MSV, Mohr JP. Carotid artery dissection. Annu Rev Med. 2000;51(1):329–47.  https://doi.org/10.1146/annurev.med.51.1.329.CrossRefPubMedGoogle Scholar
  33. 33.
    Naggara O, Louillet F, Touzé E, Roy D, Leclerc X, Mas J-L, et al. Added value of high-resolution MR imaging in the diagnosis of vertebral artery dissection. AJNR Am J Neuroradiol. 2010;31(9):1707–12.  https://doi.org/10.3174/ajnr.A2165.CrossRefPubMedGoogle Scholar
  34. 34.
    Leclerc X, Godefroy O, Salhi A, Lucas C, Leys D, Pruvo JP. Helical CT for the diagnosis of extracranial internal carotid artery dissection. Stroke. 1996;27(3):461–6. http://www.ncbi.nlm.nih.gov/pubmed/8610314.CrossRefPubMedGoogle Scholar
  35. 35.
    Vertinsky AT, Schwartz NE, Fischbein NJ, Rosenberg J, Albers GW, Zaharchuk G. Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol. 2008;29(9):1753–60.  https://doi.org/10.3174/ajnr.A1189.CrossRefPubMedGoogle Scholar
  36. 36.
    Sturzenegger M, Mattle HP, Rivoir A, Rihs F, Schmid C. Ultrasound findings in spontaneous extracranial vertebral artery dissection. Stroke. 1993;24(12):1910–21. http://www.ncbi.nlm.nih.gov/pubmed/7902621.CrossRefPubMedGoogle Scholar
  37. 37.
    Alecu C, Fortrat JO, Ducrocq X, Vespignani H, de Bray JM. Duplex scanning diagnosis of internal carotid artery dissections. A case control study. Cerebrovasc Dis. 2007;23(5–6):441–7.  https://doi.org/10.1159/000101469.CrossRefPubMedGoogle Scholar
  38. 38.
    Zinkstok SM, Vergouwen MDI, Engelter ST, Lyrer PA, Bonati LH, Arnold M, et al. Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data. Stroke. 2011;42(9):2515–20.  https://doi.org/10.1161/STROKEAHA.111.617282.CrossRefPubMedGoogle Scholar
  39. 39.
    CADISS Trial Investigators, Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14(4):361–7.  https://doi.org/10.1016/S1474-4422(15)70018-9.CrossRefGoogle Scholar
  40. 40.
    Kasner SE. CADISS: a feasibility trial that answered its question. Lancet Neurol. 2015;14(4):342–3.  https://doi.org/10.1016/S1474-4422(14)70271-6.CrossRefPubMedGoogle Scholar
  41. 41.
    Kennedy F, Lanfranconi S, Hicks C, Reid J, Gompertz P, Price C, CADISS Investigators, et al. Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 2012;79(7):686–9.  https://doi.org/10.1212/WNL.0b013e318264e36b.CrossRefPubMedGoogle Scholar
  42. 42.
    Chowdhury MM, Sabbagh CN, Jackson D, Coughlin PA, Ghosh J. Antithrombotic treatment for acute extracranial carotid artery dissections: a meta-analysis. Eur J Vasc Endovasc Surg. 2015;50(2):148–56.  https://doi.org/10.1016/j.ejvs.2015.04.034.CrossRefPubMedGoogle Scholar
  43. 43.
    Droste DW, Junker K, Stögbauer F, Lowens S, Besselmann M, Braun B, Ringelstein EB. Clinically silent circulating microemboli in 20 patients with carotid or vertebral artery dissection. Cerebrovasc Dis. 2001;12(3):181–5.  https://doi.org/10.1159/000047701.CrossRefPubMedGoogle Scholar
  44. 44.
    Molina CA, Alvarez-Sabín J, Schonewille W, Montaner J, Rovira A, Abilleira S, Codina A. Cerebral microembolism in acute spontaneous internal carotid artery dissection. Neurology. 2000;55(11):1738–40. http://www.ncbi.nlm.nih.gov/pubmed/11113235.CrossRefPubMedGoogle Scholar
  45. 45.
    Nedeltchev K, Bickel S, Arnold M, Sarikaya H, Georgiadis D, Sturzenegger M, et al. R2-recanalization of spontaneous carotid artery dissection. Stroke. 2009;40(2):499–504.  https://doi.org/10.1161/STROKEAHA.108.519694.CrossRefPubMedGoogle Scholar
  46. 46.
    Engelter ST, Brandt T, Debette S, Caso V, Lichy C, Pezzini A, Cervical Artery Dissection in Ischemic Stroke Patients (CADISP) Study Group, et al. Antiplatelets versus anticoagulation in cervical artery dissection. Stroke. 2007;38(9):2605–11.  https://doi.org/10.1161/STROKEAHA.107.489666.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Engelter ST, Rutgers MP, Hatz F, Georgiadis D, Fluri F, Sekoranja L, et al. Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke. 2009;40(12):3772–6.  https://doi.org/10.1161/STROKEAHA.109.555953.CrossRefPubMedGoogle Scholar
  48. 48.
    Georgiadis D, Baumgartner RW. Thrombolysis in cervical artery dissection. Front Neurol Neurosci. 2005;20:140–6.  https://doi.org/10.1159/000088158.CrossRefPubMedGoogle Scholar
  49. 49.
    Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236.  https://doi.org/10.1161/STR.0000000000000024.CrossRefPubMedGoogle Scholar
  50. 50.
    Donas KP, Mayer D, Guber I, Baumgartner R, Genoni M, Lachat M. Endovascular repair of extracranial carotid artery dissection: current status and level of evidence. J Vasc Interv Radiol. 2008;19(12):1693–8.  https://doi.org/10.1016/j.jvir.2008.08.025.CrossRefPubMedGoogle Scholar
  51. 51.
    Biller J, Sacco RL, Albuquerque FC, Demaerschalk BM, Fayad P, Long PH, American Heart Association Stroke Council, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(10):3155–74.  https://doi.org/10.1161/STR.0000000000000016.CrossRefPubMedGoogle Scholar
  52. 52.
    Biffl WL, Moore EE, Ryu RK, Offner PJ, Novak Z, Coldwell DM, et al. The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. Ann Surg. 1998;228(4):462–70. http://www.ncbi.nlm.nih.gov/pubmed/9790336.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Fabian TC, Patton JH, Croce MA, Minard G, Kudsk KA, Pritchard FE. Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. Ann Surg. 1996;223(5):513–22. http://www.ncbi.nlm.nih.gov/pubmed/8651742.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Burlew CC, Biffl WL, Moore EE, Barnett CC, Johnson JL, Bensard DD. Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis. J Trauma Acute Care Surg. 2012;72(2):330–5. Discussion 336–7, quiz 539.  https://doi.org/10.1097/TA.0b013e31823de8a0.CrossRefPubMedGoogle Scholar
  55. 55.
    Miller PR, Fabian TC, Bee TK, Timmons S, Chamsuddin A, Finkle R, Croce MA. Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma. 2001;51(2):279–85. http://www.ncbi.nlm.nih.gov/pubmed/11493785.CrossRefPubMedGoogle Scholar
  56. 56.
    Bromberg WJ, Collier BC, Diebel LN, Dwyer KM, Holevar MR, Jacobs DG, et al. Blunt cerebrovascular injury practice management guidelines: the eastern association for the surgery of trauma. J Trauma. 2010;68(2):471–7.  https://doi.org/10.1097/TA.0b013e3181cb43da.CrossRefPubMedGoogle Scholar
  57. 57.
    Beletsky V, Nadareishvili Z, Lynch J, Shuaib A, Woolfenden A, Norris JW, Canadian Stroke Consortium. Cervical arterial dissection: time for a therapeutic trial? Stroke. 2003;34(12):2856–60.  https://doi.org/10.1161/01.STR.0000098649.39767.BC.CrossRefPubMedGoogle Scholar
  58. 58.
    Leys D, Bandu L, Hénon H, Lucas C, Mounier-Vehier F, Rondepierre P, Godefroy O. Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology. 2002;59(1):26–33. http://www.ncbi.nlm.nih.gov/pubmed/12105303.CrossRefPubMedGoogle Scholar
  59. 59.
    Schievink WI, Mokri B, O’Fallon WM. Recurrent spontaneous cervical-artery dissection. N Engl J Med. 1994;330(6):393–7.  https://doi.org/10.1056/NEJM199402103300604.CrossRefPubMedGoogle Scholar
  60. 60.
    Dziewas R, Konrad C, Dräger B, Evers S, Besselmann M, Lüdemann P, et al. Cervical artery dissection—clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 2003;250(10):1179–84.  https://doi.org/10.1007/s00415-003-0174-5.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  1. 1.Neurology in Stroke, Department of NeurologyCreighton University School of Medicine/CHI HealthOmahaUSA
  2. 2.Department of SurgerySt. John Hospital and Medical CentersDetroitUSA

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