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Carotid Artery Dissection

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Neurovascular Imaging

Abstract

Carotid artery dissections (CAD) are a leading cause of nonatherosclerotic stroke in young adults, responsible for up to 25 % of ischemic strokes. The cornerstone of CAD pathophysiology and diagnosis is the presence of a mural hematoma of unknown etiology, possibly caused by an intimal tear, a primary rupture of vasa vasorum, or an underlying arteriopathy impairing vasomotion. This mural hematoma occurs within the media layer extending distally and circumferentially. The diagnosis of CAD is generally based on a suggestive clinical presentation, exclusion of atherosclerosis, and supportive radiologic evidence. An early and reliable diagnosis is important as anticoagulation or antithrombotic treatment is recommended in order to reduce the risk of an early thromboembolic event. The optimal imaging method for the diagnosis of CAD is still debated. Doppler ultrasound examination (DUS), the first-line screening tool, may show normal findings whenever the mural hematoma results in subtle lumen alterations or is located in a segment that cannot readily be displayed by DUS. Despite the ability of CT angiography to reveal imaging findings of CAD, brain CT is known to be poorly sensitive for the detection of ischemic lesions. Thus, cervical contrast-enhanced MR angiography (CE-MRA) coupled with T1-WI fat-suppressed axial sequences has gradually replaced conventional angiography for the diagnosis of cervical artery dissection. However, the diagnosis of CAD often remains challenging, and it is not rare for the diagnosis of CAD to remain presumptive despite an extensive imaging work-up. The diagnosis can be retrospectively confirmed on imaging follow-up by monitoring the lumen healing or progression in response to treatment. High-resolution MRI (HR-MRI) of the arterial wall is a noninvasive imaging technique that provides a delineation of the lumen and arterial wall. This technique, available at 1.5 and 3-T, which requires standard or dedicated surface coils, has been extensively used for carotid atherosclerosis and, more recently, for carotid dissection.

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Authors and Affiliations

  1. Service de Neuroradiologie, Centre Hospitalier Sainte-Anne, INSERM UMR894, Université Paris Descartes, Sorbonne Paris Cité, 1 rue Cabanis, 75014, Paris, France

    Olivier Naggara, Myriam Edjlali-Goujon, Marie Pierre Gobin-Metteil, Denis Trystram, Christine Rodriguez-Regent, Jean Francois Meder & Catherine Oppenheim

  2. Service de Radiologie pédiatrique, Faculté de Médecine, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, rue de Sèvre, 75007, Paris, France

    Olivier Naggara

  3. Service de Neurologie, Faculté de Médecine, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, 1 rue Cabanis, 75014, Paris, France

    Eric Bodiguel & Jean-Louis Mas

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  1. Olivier Naggara
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  1. Department of Radiology, AOU of Cagliari, Monserrato, Cagliari, Italy

    Luca Saba

  2. Neurointerventional Radiology Section, Department of Radiology, NYU Langone Medical Center, New York, NY, USA

    Eytan Raz

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Naggara, O. et al. (2016). Carotid Artery Dissection. In: Saba, L., Raz, E. (eds) Neurovascular Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9029-6_16

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