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Carotid and Vertebral Dissection Imaging

  • Imaging (L Mechtler, Section Editor)
  • Published:
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Abstract

Carotid or vertebral artery dissection is the result of a tear in the vessel lining wherein the intima separates the media. This creates a false or pseudo lumen, often accompanied by hemorrhage into the arterial wall. Dissection of these craniocervical vessels often manifests with pain alone but, if untreated, may result in severe neurologic compromise. The causes of dissection are multifactorial, including spontaneous, iatrogenic, and traumatic insults. Regardless of etiology, treatment consists primarily of anticoagulation, whereas endovascular therapy is reserved for cases with persistent thrombus or flow limitation. Given the high risk of neurological compromise or death and the propensity of these injuries to occur in younger individuals, early diagnosis of carotid and vertebral artery dissections is critical. Although angiography remains the criterion standard for diagnosis, advances in noninvasive imaging have placed magnetic resonance and computed tomography at the forefront of diagnosis. This article examines the current imaging modalities used to diagnose this under-recognized entity.

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Abbreviations

CT:

Computed tomography

CTA:

Computed tomographic angiography

DSA:

Digital subtraction angiography

MR:

Magnetic resonance

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

TOF:

Time-of-flight

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Acknowledgments

The authors thank Paul H. Dressel BFA for preparation of the figures and Debra J. Zimmer for editorial assistance.

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Authors and Affiliations

  1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

    Hakeem J. Shakir, Jason M. Davies, Hussain Shallwani, Adnan H. Siddiqui & Elad I. Levy

  2. Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA

    Hakeem J. Shakir, Jason M. Davies, Hussain Shallwani, Adnan H. Siddiqui & Elad I. Levy

  3. Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

    Adnan H. Siddiqui & Elad I. Levy

  4. Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA

    Adnan H. Siddiqui

  5. Jacobs Institute, Buffalo, NY, USA

    Adnan H. Siddiqui

  6. University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY, 14203, USA

    Hakeem J. Shakir, Jason M. Davies, Hussain Shallwani, Adnan H. Siddiqui & Elad I. Levy

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  1. Hakeem J. Shakir
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Corresponding author

Correspondence to Elad I. Levy.

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Conflict of Interest

Hakeem J. Shakir, Jason M. Davies, and Hussain Shallwani declare that they have no conflict of interest.

Adnan H. Siddiqui declares financial interests in Buffalo Technology Partners Inc., Cardinal, International Medical Distribution Partners; Medina Medical Systems, Neuro technology Investors, StimSox, and Valor Medical. He serves as a consultant to Amnis Therapeutics Ltd., Cerebrotech Medical Systems Inc., CereVasc LLC, Codman, Corindus Inc., Covidien (acquired by Medtronic), GuidePoint Global Consulting, Lazarus (acquired by Medtronic), Medina Medical (acquired by Medtronic), Medtronic, MicroVention, Neuravi, Penumbra, Pulsar Vascular, Rapid Medical, Rebound Medical, Reverse Medical (acquired by Medtronic), Silk Road Medical Inc., Stryker, The Stroke Project Inc., Three Rivers Medical Inc., and W.L. Gore & Associates. He is aprincipal investigator or serves on the National Steering Committee for the following trials: Covidien SWIFT PRIME, LARGE, Medtronic SWIFT DIRECT, MicroVention CONFIDENCE, MicroVention FRED, Penumbra 3D Separator, Penumbra COMPASS, Penumbra INVEST, and POSITIVE Trial. He is a member of the board of the Intersocietal Accreditation Committee. (Dr. Siddiqui receives no consulting salary arrangements. All consulting is per project and/or per hour.)

Elad I. Levy declares shareholder/ownership interests in Intratech Medical Ltd., Blockade Medical LLC, and NeXtGen Biologics. He serves as a national principal investigator for the Covidien US SWIFT PRIME Trials and receives honoraria for training and lecturing from that company. He receives compensation from Abbott for carotid training sessions for physicians. He serves as a consultant to Pulsar and Blockade Medical and on the Acute Ischemic Stroke Clinical Advisory Board for Stryker and the Advisory Board for NeXtGen Biologics and MEDX.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Imaging

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Shakir, H.J., Davies, J.M., Shallwani, H. et al. Carotid and Vertebral Dissection Imaging. Curr Pain Headache Rep 20, 68 (2016). https://doi.org/10.1007/s11916-016-0593-5

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  • DOI: https://doi.org/10.1007/s11916-016-0593-5

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