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Surgical Management of Cerebrovascular Disease pp 57–61Cite as

Management of Spontaneous Dissection of the Cervical Carotid Artery

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Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 107))

Abstract

This manuscript reviews the management of patients with spontaneous dissection of the cervical internal carotid artery (sICAD). Recommendations are not based on controlled-randomized trials, but on case-control and observational, hospital-based studies, and case reports. Vascular risk factors seem to be as prevalent in patients with sICAD as in age-matched, healthy volunteers. Stroke prevention includes the treatment of vascular risk factors and the administration of oral aspirin, which may be as effective as anticoagulation. The few available data indicate that most patients with sICAD causing severe stenosis or occlusion, or an aneurysm can be treated conservatively. Patients with sICAD were not excluded in the intravenous controlled-randomized thrombolysis trials with tissue plasminogen activator, but were excluded in the intraarterial controlled-randomized thrombolysis trials. Taking the few published case series and reports on thrombolysis in patients with sICAD into consideration, intravenous thrombolysis may be beneficial, whereas it remains unclear whether intraarterial thrombolysis is useful.

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References

  1. Mancia G, Parati G, Castiglioni P et al (2003) Daily life blood pressure changes are steeper in hypertensive than in normotensive subjects. Hypertension 42:277–282

    Article  PubMed  CAS  Google Scholar 

  2. Baumgartner RW (2008) Stroke prevention and treatment of spontaneous carotid dissection. Acta Neurochir Suppl 103:47–50

    Article  PubMed  CAS  Google Scholar 

  3. Arnold M, Pannier B, Chabriat H, Nedeltchev K, Stapf C et al (2009) Vascular risk factors and morphometric data in cervical artery dissection: a case-control study. J Neurol Neurosurg Psychiatr 80:232–234

    Article  PubMed  CAS  Google Scholar 

  4. Pezzini A, Caso V, Zanferrari C, Del Zotto E, Paciaroni M et al (2006) Arterial Hypertension as risk factor for spontaneous cervical artery dissection: a case-control study. J Neurol Neurosurg Psychiatr 77:95–97

    Article  PubMed  CAS  Google Scholar 

  5. Arnold M, Kappeler L, Georgiadis D, Berthet K, Keserue B et al (2006) Gender differences in spontaneous cervical artery dissection. Neurology 67:1050–1052

    Article  PubMed  CAS  Google Scholar 

  6. Marti B, Rickenbach M, Keil U, Stieber J, Greiser E et al (1990) Variation in coronary risk factor levels of men and women between the German-speaking MONICA centres. Rev Epidemiol Sante Publique 38:479–486

    PubMed  CAS  Google Scholar 

  7. Keller U (1990) Serum cholesterol of Swiss military personnel and assessment of nutrition in military service. Schweiz Rundsch Med Prax 79:1079–1084

    PubMed  CAS  Google Scholar 

  8. Marques-Vidal P, Ruidavets JB, Amouyel P, Ducimetiere P, Arveiler D et al (2004) Change in cardiovascular risk factors in France, 1985–1997. Eur J Epidemiol 19:25–32

    Article  PubMed  CAS  Google Scholar 

  9. Baumgartner RW, Arnold M, Baumgartner I, Mosso M, Gönner F et al (2001) Carotid dissection with and without ischemic events: Local symptoms and cerebral artery findings. Neurology 57:827–832

    PubMed  CAS  Google Scholar 

  10. Benninger DH, Herrmann FR, Georgiadis D, Kretschmer R, Sarikaya H et al (2009) Increased prevalence of hyperhomocysteinemia in cervical artery dissection causing stroke. A case-control study. Cerebrovasc Dis 27:241–246

    Article  PubMed  CAS  Google Scholar 

  11. Gallai V, Caso V, Paciaroni M, Cardioli G, Arning E et al (2001) Mild hyperhomocysteinemia: a possible risk factor for cervical artery dissection. Stroke 32:714–718

    Article  PubMed  CAS  Google Scholar 

  12. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K et al (2004) Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. J Neurol 251:1242–1248

    Article  PubMed  CAS  Google Scholar 

  13. Pezzini A, Del Zotto E, Archetti S, Negrini R, Bani P et al (2002) Plasma homocysteine concentration, C677T MTHFR genotype, and 844ins68bp CBS genotype in young adults with spontaneous cervical artery dissection and atherothrombotic stroke. Stroke 33:664–669

    Article  PubMed  CAS  Google Scholar 

  14. Kelly PJ, Rosand J, Kistler JP, Shih VE, Silveira S et al (2002) Homocysteine, MTHFR 677C-T polymorphism, and risk of ischemic stroke–results of a meta-analysis. Neurology 59:529–536

    PubMed  CAS  Google Scholar 

  15. Soriente L, Coppola A, Madonna P, Cerbone AM, Di Minno G et al (1998) Homozygous C677T mutation of the 5, 10 methylenetetrahydrofolate reductase gene and hyperhomocysteinemia in Italian patients with a history of early-onset ischemic stroke. Stroke 29:869–871

    Article  PubMed  CAS  Google Scholar 

  16. Harker LA, Ross R, Slichter SJ, Scott CR (1976) Homocysteine-induced arteriosclerosis: the role of endothelial cell injury and platelet response in its genesis. J Clin Invest 58:731–741

    Article  PubMed  CAS  Google Scholar 

  17. Harker LA, Slichter J, Scott CR, Russell R (1974) Homocystinemia. Vascular injury and arterial thrombosis. N Engl J Med 291:537–543

    Article  PubMed  CAS  Google Scholar 

  18. Wall RT, Harlan JM, Harker LA, Striker GF (1980) Homocysteine-induced endothelial cell injury in vitro: a model for the study of vascular injury. Thromb Res 18:113–121

    Article  PubMed  CAS  Google Scholar 

  19. Woo KS, Chook P, Lolin YI, Cheung AS, Chan LT et al (1997) Hyperhomocysteinemia is a risk factor for endothelial dysfunction in humans. Circulation 96:2542–2544

    PubMed  CAS  Google Scholar 

  20. Boers GH, Smals AG, Trijbels FJ, Fowler B, Bakkeren JA et al (1985) Heterozygosity for homocystinuria in premature peripheral and cerebral occlusive arterial disease. N Engl J Med 313:709–715

    Article  PubMed  CAS  Google Scholar 

  21. Clarke R, Daly L, Robinson K, Naughten E, Cahalane S et al (1991) Hyperhomocysteinemia: an independent risk factor for vascular disease. N Engl J Med 324:1149–1155

    Article  PubMed  CAS  Google Scholar 

  22. Abboud H, Houdart E, Meseguer E, Amarenco P (2005) Stent assisted endovascular thrombolysis of internal carotid artery dissection. J Neurol Neurosurg Psychiatry 76:292–293

    Article  PubMed  CAS  Google Scholar 

  23. Albers GW, Clark WM, Madden KP, Hamilton SA (2002) ATLANTIS trial. Results for patients treated within 3 hours of stroke onset. Stroke 33:493–496

    Article  PubMed  Google Scholar 

  24. Brattstrom L, Wilcken DE (2000) Homocysteine and cardiovascular disease: cause or effect? Am J Clin Nutr 72:315–323

    PubMed  CAS  Google Scholar 

  25. Christen WG, Ajani UA, Glynn RJ, Hennekens CH (2000) Blood levels of homocysteine and increased risk of cardiovascular disease: causal or casual? Arch Int Med 160:422–434

    Article  CAS  Google Scholar 

  26. Grau AJ, Brandt T, Buggle F, Orbek E, Mytilineos J et al (1999) Association of cervical artery dissection with recent infection. Arch Neurol 56:851–856

    Article  PubMed  CAS  Google Scholar 

  27. Guillon B, Lévy C, Bousser MG (1998) Internal carotid artery dissection: an update. J Neurol Sci 153:146–158

    Article  PubMed  CAS  Google Scholar 

  28. Lindgren A, Brattstrom L, Norrving B, Hultberg B, Andersson A, Johansson BB (1995) Plasma homocysteine in the acute and convalescent phases after stroke. Stroke 26:795–800

    Article  PubMed  CAS  Google Scholar 

  29. Nurk E, Tell GS, Nygard O, Refsum H, Ueland PM, Vollset SE (2001) Plasma total homocysteine is influenced by prandial status in humans. The Hordaland homocysteine study. J Nutr 131:1214–1216

    PubMed  CAS  Google Scholar 

  30. Erkula G, Jones KB, Sponseller PD, Dietz HC, Dieritz RE (2002) Growth and maturation in Marfan syndrome. Am J Med Genet 10:1000–1015

    Google Scholar 

  31. Benninger DH, Georgiadis D, Kremer C, Studer A, Nedeltchev K, Baumgartner RW (2004) Mechanism of ischemic infarct in spontaneous carotid dissection. Stroke 35:482–485

    Article  PubMed  CAS  Google Scholar 

  32. Srinivasan J, Newell DW, Sturzenegger M, Mayberg MR, Winn HR (1996) Transcranial Doppler in the evaluation of internal carotid artery dissection. Stroke 27:1226–1230

    Article  PubMed  CAS  Google Scholar 

  33. Lyrer P, Engelter S (2004) Antithrombotic drugs for carotid artery dissection. Stroke 35:613–614

    Article  PubMed  Google Scholar 

  34. Georgiadis D, Arnold M, von Buedingen HC, Valko P, Sarikaya H, et al (2009) Aspirin versus anticoagulation in carotid artery dissection: a study of 298 patients. Neurology 2009;72:1810–5

    Google Scholar 

  35. Nedeltchev K, Bickel S, Arnold M, Sarikaya H, Georgiadis D et al (2009) Recanalization of spontaneous carotid artery dissection. Stroke 40:499–504

    Article  PubMed  Google Scholar 

  36. Kremer C, Mosso M, Georgiadis D, Stöckli E, Benninger D et al (2003) Carotid dissection with permanent and transient occlusion or severe stenosis: Long-term outcome. Neurology 60:271–275

    PubMed  CAS  Google Scholar 

  37. Leys D, Moulin T, Stoijkovic T, Begey S, Chavot D, Investigators DONALD (1995) Follow-up of patients with history of cervical artery dissection. Cerebrovasc Dis 5:43–49

    Article  Google Scholar 

  38. Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S et al (2003) Risk of stroke and recurrent dissection after a cervical artery dissection. A multicenter study. Neurology 61:1347–1351

    PubMed  Google Scholar 

  39. Benninger DH, Gandjour J, Georgiadis D, Stöckli E, Arnold M, Baumgartner RW (2007) Benign long-term outcome of conservatively treated cervical aneurysms due to carotid dissection. Neurology 69:486–487

    Article  PubMed  CAS  Google Scholar 

  40. Guillon B, Brunerau L, Biousse V, Djouhri H, Lévy C, Bousser MG (1999) Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection. Neurology 53:117–122

    PubMed  CAS  Google Scholar 

  41. Touzé E, Randoux B, Méary E, Arquizan C, Meder J-F, Mas J-L (2001) Aneurysmal forms of cervical artery dissection. Associated factors and outcome. Stroke 32:418–423

    Article  PubMed  Google Scholar 

  42. Georgiadis D, Baumgartner RW (2005) Thrombolysis in cervical artery dissection. In: Baumgartner RW, Bogousslavsky J, Caso V, Paciaroni M (eds) Handbook on Cerebral Artery Dissection. Karger, Basel, pp 140–146

    Chapter  Google Scholar 

  43. Clark WM, Wissman M, Albers GW, Jhamandas JH, Madden KP et al (1999) Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. JAMA 282:2019–2026

    Article  PubMed  CAS  Google Scholar 

  44. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 274:1017–1025

    Article  PubMed  CAS  Google Scholar 

  45. The National Institute of Neurological Disorders and Stroke rt-PA Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Article  Google Scholar 

  46. Derex L, Nighoghossian N, Turjman F, Hermier M, Honnorat J et al (2000) Intravenous tPA in acute ischemic stroke related to internal carotid artery dissection. Neurology 54:2159–2161

    PubMed  CAS  Google Scholar 

  47. Georgiadis D, Schwab S, Engelter S, Sztajzel R, Arnold M et al (2005) Intravenous thrombolysis in patients with acute stroke due to spontaneous carotid dissection. Neurology 64:1612–1614

    Article  PubMed  CAS  Google Scholar 

  48. Rudolf J, Neveling M, Grond M, Schmulling S, Stenzel C, Heiss W (1999) Stroke following internal carotid artery occlusion - a contra-indication for intravenous thrombolysis? Eur J Neurol 6:51–55

    Article  PubMed  CAS  Google Scholar 

  49. Del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA et al (1998) PROACT: a phase I randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke 29:4–11

    Article  PubMed  Google Scholar 

  50. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H et al (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. JAMA 282:2003–2011

    Article  PubMed  CAS  Google Scholar 

  51. Ogawa A, Mori E, Minematsu K, Taki W, Takahashi A et al (2007) Randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke. The middle cerebral artery embolism local fibrinolytic Intervention trial (MELT) Japan. Stroke 38:2633–2639

    Article  PubMed  CAS  Google Scholar 

  52. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS et al (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke. Results of the MERCI trial. Stroke 36:1432–1440

    Article  PubMed  Google Scholar 

  53. Arnold M, Nedeltchev K, Sturzenegger M, Schroth G, Loher TJ et al (2002) Thrombolysis in patients with acute stroke caused by cervical artery dissection: analysis of 9 patients and review of the literature. Arch Neurol 59:549–553

    Article  PubMed  Google Scholar 

  54. Sampognaro G, Turgut T, Conners J Jr, White C, Collins T, Ramee SR (1999) Intra-arterial thrombolysis in a patient presenting with an ischemic stroke due to spontaneous internal carotid artery dissection. Catheter Cardiovasc Interv 48:312–315

    Article  PubMed  CAS  Google Scholar 

  55. Zaidat OO, Fernandes Filho JA, Singh G, Suarez JI (2001) Thrombolytic therapy for acute extra-cranial artery dissection: report of two cases. Arq Neuropsiquiatr 59:936–938

    Article  PubMed  CAS  Google Scholar 

  56. Nedeltchev K, Brekenfeld C, Remonda L, Ozdoba C, Dai-Do D et al (2005) Internal carotid artery stent implantation in 25 patients with acute stroke: Preliminary results. Radiology 237:1029–1037

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, University Hospital of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland

    Ralf W. Baumgartner

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Correspondence to Ralf W. Baumgartner .

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Baumgartner, R.W. (2010). Management of Spontaneous Dissection of the Cervical Carotid Artery. In: Surgical Management of Cerebrovascular Disease. Acta Neurochirurgica Supplementum, vol 107. Springer, Vienna. https://doi.org/10.1007/978-3-211-99373-6_9

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  • DOI: https://doi.org/10.1007/978-3-211-99373-6_9

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