European Radiology

, Volume 17, Issue 3, pp 820–834 | Cite as

Carotid and vertebral artery dissections: clinical aspects, imaging features and endovascular treatment

  • Christine M. Flis
  • H. Rolf Jäger
  • Paul S. Sidhu
Neuro

Abstract

Extracranial arterial dissections are a recognised cause of stroke, particularly in young adults. Clinical diagnosis may be difficult, and the classical triad of symptoms is uncommon. Imaging plays a pivotal role in the diagnosis of extracranial arterial dissections, and this review provides a detailed discussion of the relative merits and limitations of currently available imaging modalities. Conventional arteriography has been the reference standard for demonstrating an intimal flap and double lumen, which are the hallmarks of a dissection, and for detecting complications such as stenosis, occlusion or pseudoaneurysm. Noninvasive vascular imaging methods, such as ultrasound (US), magnetic resonance angiography (MRA) and computed tomography angiography (CTA) are increasingly replacing conventional angiography for the diagnosis of carotid and vertebral dissections. Ultrasound provides dynamic and “real-time” information regarding blood flow. Source data of MRA and CTA and additional cross-sectional images can provide direct visualisation of the mural haematoma and information about the vessel lumen. Anticoagulation to prevent strokes is the mainstay of medical treatment, but randomised trials to define the optimal treatment regime are lacking. Surgery has a limited role in management of dissections, but endovascular procedures are gaining importance for treatment of complications and if medical management fails.

Keywords

Carotid arteries, dissection Carotid arteries US MR CT Interventional procedures 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Christine M. Flis
    • 1
  • H. Rolf Jäger
    • 2
  • Paul S. Sidhu
    • 1
    • 2
  1. 1.Department of RadiologyKing’s College HospitalDenmark HillUK
  2. 2.Lysholm Department of NeuroradiologyNational Hospital for Neurology and NeurosurgeryQueen SquareUK

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