Cervical carotid artery dissection: current review of diagnosis and treatment
Raj Ramabhai Patel1, Richard Adam, Catherine Maldjian
1Department of Radiology, Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, USA. rajpatel33@gmail.com
Insights
Carotid artery dissection, a cause of stroke in younger adults, involves artery wall damage. Diagnosis is improving with imaging, but treatment remains controversial due to spontaneous healing.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Carotid artery dissection is a significant cause of stroke, particularly in young and middle-aged individuals.
- It results from intimal tears or vasa vasorum rupture, forming an intramural hematoma, often linked to trauma or spontaneous, multifactorial causes.
- Clinical diagnosis can be difficult, with symptoms like pain, Horner syndrome, cranial nerve palsies, or ischemic events.
Purpose of the Study:
- To review the current understanding of carotid artery dissection, including its causes, diagnosis, and management.
- To highlight the increasing diagnostic frequency due to advancements in noninvasive imaging techniques.
Main Methods:
- Review of existing literature on carotid artery dissection.
- Analysis of diagnostic modalities, focusing on magnetic resonance and computed tomography angiography.
- Discussion of current and potential treatment strategies.
Main Results:
- Noninvasive imaging has significantly increased the detection rate of carotid artery dissections.
- A range of treatments exist, including thrombolysis, antiplatelet/anticoagulant therapy, and surgical or endovascular interventions.
- Most carotid dissections demonstrate spontaneous healing.
Conclusions:
- The optimal treatment for carotid artery dissection remains debated due to the lack of comparative randomized trials.
- The natural history of spontaneous healing complicates treatment decisions.
Abstract:
Carotid artery dissection is a cause of stroke, especially in young and middle-aged patients. A dissection occurs when there is an intimal tear or rupture of the vasa vasorum, leading to an intramural hematoma, which is thought to result from trauma or can occur spontaneously, and is likely multifactorial, involving environmental and intrinsic factors. The clinical diagnosis of carotid artery dissection can be challenging, with common presentations including pain, partial Horner syndrome, cranial nerve palsies, or cerebral ischemia. With the use of noninvasive imaging, including magnetic resonance and computed tomography angiography, the diagnosis of carotid dissection has increased in frequency. Treatment options include thrombolysis, antiplatelet or anticoagulation therapy, endovascular or surgical interventions. The choice of appropriate therapy remains controversial as most carotid dissections heal on their own and there are no randomized trials to compare treatment options.
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