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The diagnosis and management of supraaortic arterial dissections

Manu S Goyal1, Colin P Derdeyn

  • 1Department of Neurology, Washington University School of Medicine, St Louis, Missouri 63110, USA.

Current Opinion in Neurology
|January 27, 2009
PubMed

Insights

Recent advances show supraaortic arterial dissections are a key cause of stroke. Diagnosis and management require tailored imaging and treatment, often involving a multidisciplinary approach for best outcomes.

Area of Science:

  • Vascular Neurology
  • Neuroradiology
  • Interventional Cardiology

Background:

  • Supraaortic arterial dissections, affecting carotid and vertebral arteries, are increasingly recognized as significant causes of stroke and subarachnoid hemorrhage.
  • Minor trauma combined with underlying arteriopathy is a frequent etiology.
  • The diverse pathological changes post-dissection complicate accurate imaging diagnosis.

Purpose of the Study:

  • To review recent advancements in the understanding of supraaortic arterial dissections.
  • To discuss contemporary diagnostic modalities for these dissections.
  • To outline current management strategies for supraaortic arterial dissections.

Main Methods:

  • Review of current literature on supraaortic arterial dissections.
  • Analysis of diagnostic imaging techniques including ultrasound, MRI/MRA, CTA, and DSA.
  • Evaluation of treatment options ranging from antiplatelet therapy to endovascular interventions.

Main Results:

  • Imaging diagnosis necessitates tailoring modalities (ultrasound, MRI, CTA, DSA) to individual patient profiles.
  • Treatment strategies are variable, encompassing antiplatelet agents, endovascular techniques, and surgical interventions.
  • Conservative management is often optimal for cervical dissections, while ruptured dissecting aneurysms demand urgent intervention.

Conclusions:

  • The diagnosis and management of supraaortic arterial dissections present considerable complexity.
  • A variable, multidisciplinary approach is crucial for optimizing patient outcomes.
  • Further research is needed to guide treatment decisions, particularly for stroke secondary to arterial dissection.
Abstract

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