Skip to main content
SpringerLink
Log in

Cervical (Carotid and Vertebral) Artery Dissection

  • Chapter
  • First Online:
Extracranial Carotid and Vertebral Artery Disease

  • 1114 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  48. Georgiadis D, Baumgartner RW. Thrombolysis in cervical artery dissection. Front Neurol Neurosci. 2005;20:140–6. https://doi.org/10.1159/000088158.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurology in Stroke, Department of Neurology, Creighton University School of Medicine/CHI Health, Omaha, NE, USA

    Vishal B. Jani

  2. Department of Surgery, St. John Hospital and Medical Centers, Detroit, MI, USA

    Richard D. Fessler

Authors
  1. Vishal B. Jani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard D. Fessler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard D. Fessler .

Editor information

Editors and Affiliations

  1. Wayne State University School of Medicine, Detroit, MI, USA

    Sachinder Singh Hans

Rights and permissions

Reprints and permissions

Copyright information

© 2018 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jani, V.B., Fessler, R.D. (2018). Cervical (Carotid and Vertebral) Artery Dissection. In: Hans, S. (eds) Extracranial Carotid and Vertebral Artery Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-91533-3_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-91533-3_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91532-6

  • Online ISBN: 978-3-319-91533-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation