Cervical Carotid Artery Dolichoectasia as a Marker of Increased Vascular Risk
Farid Khasiyev1, Jose Gutierrez2
1Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO.
Insights
Cervical carotid artery dolichoectasia (cCA DE) involves abnormal artery widening and lengthening. Studies suggest cCA DE may increase vascular event risk, warranting further research into its causes and management.
Area of Science:
- Vascular Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Cervical carotid artery dolichoectasia (cCA DE) is defined by arterial elongation, tortuosity, and dilatation.
- Prevalence varies, with population-based studies reporting 13-31% and hospital-based studies 14-58%.
- The underlying mechanisms of cCA DE remain unclear, with conflicting evidence regarding atherosclerosis as the primary cause.
Purpose of the Study:
- To review the current understanding of cervical carotid artery dolichoectasia (cCA DE).
- To explore potential mechanisms, associated conditions, and risks of vascular events in individuals with cCA DE.
- To provide recommendations for managing stroke patients with cCA DE.
Main Methods:
- Literature review and synthesis of existing epidemiological and clinical studies on cCA DE.
- Analysis of cross-sectional and prospective data associating cCA DE with cerebrovascular diseases and vascular events.
- Evaluation of diagnostic criteria and measurement methods for cCA DE.
Main Results:
- cCA DE is linked to carotid dissections and inconsistently to vascular risk factors.
- Cross-sectional studies associate cCA DE with cerebrovascular disease, including white matter hyperintensities and stroke.
- Prospective data suggest an increased risk of vascular events in individuals with cCA DE, though stroke risk specifically requires further investigation.
Conclusions:
- Non-atherosclerotic mechanisms, such as connective tissue remodeling, may contribute to cCA DE.
- Objective measures like carotid length are recommended for consistent assessment of cCA DE.
- Stroke patients with cCA DE, in the absence of other causes, should be treated as cryptogenic stroke with antiplatelet therapy, pending further research on targeted interventions.
Abstract:
Cervical carotid artery (cCA) dolichoectasia (DE) is characterized by elongation, tortuosity, and/or dilatation. The prevalence of cCA DE has been reported 13-31% in population-based and 14-58% in hospital-based studies. The exact mechanisms of this aberrant arterial remodeling are unknown. Although atherosclerosis has often been implicated, the evidence has conflicting results that would support atherosclerosis as the underlying pathology. Actually, other nonatherosclerotic mechanisms related to connective tissue remodeling may play a role. Such mechanism is supported by epidemiological evidence that cCA DE is associated with carotid dissections. Similarly, cCA DE has been associated with vascular risk factors, but inconsistently. Fewer studies have evaluated the risk of vascular events in people with cCA DE. Cross-sectionally, cCA DE is associated with cerebrovascular disease, including white matter hyperintensities, lacunar stroke, and stroke overall. The often-conflicting results may in part be due to the heterogeneity of the population studies and variable definitions used. Preferential use of objective measure of cCA DE, such as carotid length, is advisable, and may help comparing result among different studies. Prospectively, people with cCA DE have a higher risk of vascular events, although it is uncertain if the risk of stroke is also higher in this population. In the absence of alternative stroke etiologies, stroke patients with cCA DE should be considered to have had a cryptogenic stroke and treated with daily antiplatelet therapy. Further population-based studies are needed to clarify whether specific therapies may be implement to reduce the risk of events among people with cCA DE.
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