Extracranial Artery Dissections

Abstract

Extracranial arterial dissections are a leading cause of strokes in young adults resulting in increased neurologic morbidity and mortality. Dissections can occur in the setting of trauma or spontaneously with a history of insignificant trauma elicited in a minority of cases. Clinical diagnosis is often challenging as most patients do not show the classic clinical triad of head, facial, or neck pain accompanied by Horner syndrome and cerebral or retinal ischemia. Imaging studies are essential in the diagnosis and traditionally conventional arteriography has been considered the gold standard. However, noninvasive imaging modalities such as computed tomography angiography and magnetic resonance angiography have replaced conventional angiography in many institutions. Cross-sectional noninvasive imaging techniques can demonstrate intramural hematomas as well as the vessel lumen and the presence of an intimal flap. Treatment usually consists of antithrombotic medication to prevent thromboembolic complications. Endovascular stenting is a treatment option in selected cases.