Sports-related internal carotid artery dissection: pathogenesis and therapeutic point of view

Extracranial and intracranial internal carotid artery (ICA) dissections following sports-related activities have been reported as a result of blunt traumatic injuries. The incidence of carotid artery dissection in sports is not known. Failure of physicians to suspect a dissection in the context of a minor injury or to obtain a history from the patient can lead to permanent neurologic deficits.

The presentation of this entity is variable. We present 2 cases of ICA dissection with differences in causative mechanism and management in order to emphasize the importance of a physician's awareness, and we review the literature on this subject.

Pathogenesis of sports-related ICA dissections may be multifactorial. Structural aberrations in the arterial walls and defective connective tissue components are assumed in some patients. Several genes have been shown to be candidates for the connective tissue aberrations. Since sports-related ICA dissection can occur extracranially or intracranially, the combined use of proper diagnostic techniques that provides information on the extracranial and intracranial vessels is recommended. Although the mechanisms and treatment modalities for intracranial and extracranial dissections might be different, the initial steps of evaluation and stabilization should be standardized for both. There is no randomized controlled study for the best treatment or management of ICA dissection.