Returning to Exercise After Valsalva-Induced Carotid Artery Dissection

Although standardized clinical guidelines are lacking, structured exercise training (ExT) can safely improve cardiorespiratory fitness and clinical outcomes after internal carotid artery dissection (ICAD) in persons with vascular Ehlers-Danlos syndrome (vEDS).

We implemented progressive ExT in a 19-year-old man with vEDS after he experienced separate, bilateral ICADs that occurred 12 months apart. The individualized ExT plan included in-clinic and at-home low- to moderate-intensity aerobic and resistance exercise.

Provider reluctance to prescribe exercise because of tissue fragility and risk of arterial rupture, combined with patient kinesiophobia, often leads people with vEDS to limit physical activity, especially after ICAD. Such patients require education and guidance to safely self-monitor and adhere to ExT.

This case demonstrates the feasibility and benefit of structured ExT after ICAD in a person with vEDS. It highlights the need to further develop evidence-based guidelines for ExT in this population.