Skip to main content

Advertisement

Log in

Opinion statement

Spontaneous and traumatic cervical artery dissection is a common cause of stroke in the young. It generally carries an excellent prognosis if treatment is initiated early. Antiplatelet therapy may be as effective as or safer than warfarin, although no randomized prospective studies have addressed the issue of optimal medical therapy. Rarely, endovascular therapy may be indicated for the treatment of ruptured aneurysms or to prevent recurrent ischemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Mokri B, Houser OW, Sandok BA, Piepgras DG: Spontaneous dissections of the vertebral arteries. Neurology 1988, 38:880–885.

    PubMed  CAS  Google Scholar 

  2. Schievink WI, Mokri B, Whisnant JP: Internal carotid artery dissection in a community. Rochester, Minnesota, 1987–1992. Stroke 1993, 24:1678–1680.

    PubMed  CAS  Google Scholar 

  3. Giroud M, Fayolle H, Andre N, et al.: Incidence of internal carotid artery dissection in the community of Dijon. J Neurol Neurosurg Psychiatry 1994, 57:1443.

    Article  PubMed  CAS  Google Scholar 

  4. Schievink WI: Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001, 344:898–906.

    Article  PubMed  CAS  Google Scholar 

  5. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B: Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006, 67:1809–1812.

    Article  PubMed  Google Scholar 

  6. Arnold M, Bousser MG, Fahrni G, et al.: Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 2006, 37:2499–2503.

    Article  PubMed  Google Scholar 

  7. Mokri B, Silbert PL, Schievink WI, Piepgras DG: Cranial nerve palsy in spontaneous dissection of the extracranial internal carotid artery. Neurology 1996, 46:356–359.

    PubMed  CAS  Google Scholar 

  8. Mazighi M, Saint Maurice JP, Rogopoulos A, Houdart E: Extracranial vertebral and carotid dissection occurring in the course of subarachnoid hemorrhage. Neurology 2005, 65:1471–1473.

    Article  PubMed  Google Scholar 

  9. Bula WI, Loes DJ: Trauma to the cerebrovascular system. Neuroimaging Clin N Am 1994, 4:753–772.

    PubMed  CAS  Google Scholar 

  10. Nedeltchev K, Baumgartner RW: Traumatic cervical artery dissection. Front Neurol Neurosci 2005, 20:54–63.

    Article  PubMed  Google Scholar 

  11. d’Anglejan CJ, Ribeiro V, Mas JL, et al.: [Dissection of the extracranial internal carotid artery. 62 cases]. Presse Med 1990, 19:661–667.

    Google Scholar 

  12. Desfontaines P, Despland PA: Dissection of the internal carotid artery: aetiology, symptomatology, clinical and neurosonological follow-up, and treatment in 60 consecutive cases. Acta Neurol Belg 1995, 95:226–234.

    PubMed  CAS  Google Scholar 

  13. Dziewas R, Konrad C, Drager B, et al.: Cervical artery dissection—clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 2003, 250:1179–1184.

    Article  PubMed  Google Scholar 

  14. Rubinstein S, Cote P: Mild mechanical traumas are possible risk factors for cervical artery dissection. Cerebrovasc Dis 2007, 24:319.

    Article  PubMed  Google Scholar 

  15. Rothwell DM, Bondy SJ, Williams JI: Chiropractic manipulation and stroke: a population-based case-control study. Stroke 2001, 32:1054–1060.

    PubMed  CAS  Google Scholar 

  16. Smith WS, Johnston SC, Skalabrin EJ, et al.: Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology 2003, 60:1424–1428.

    PubMed  CAS  Google Scholar 

  17. Anglejan-Chatillon J, Ribeiro V, Mas JL, et al.: Migraine—a risk factor for dissection of cervical arteries. Headache 1989, 29:560–561.

    Article  PubMed  Google Scholar 

  18. Tzourio C, Benslamia L, Guillon B, et al.: Migraine and the risk of cervical artery dissection: a case-control study. Neurology 2002, 59:435–437.

    PubMed  CAS  Google Scholar 

  19. Hart RG, Easton JD: Dissections. Stroke 1985, 16:925–927.

    PubMed  CAS  Google Scholar 

  20. Slovut DP, Olin JW: Fibromuscular dysplasia. N Engl J Med 2004, 350:1862–1871.

    Article  PubMed  CAS  Google Scholar 

  21. Schievink WI, Wijdicks EF, Michels VV, et al.: Heritable connective tissue disorders in cervical artery dissections: a prospective study. Neurology 1998, 50:1166–1169.

    PubMed  CAS  Google Scholar 

  22. Brandt T, Morcher M, Hausser I: Association of cervical artery dissection with connective tissue abnormalities in skin and arteries. Front Neurol Neurosci 2005, 20:16–29.

    Article  PubMed  CAS  Google Scholar 

  23. Volker W, Besselmann M, Dittrich R, et al.: Generalized arteriopathy in patients with cervical artery dissection. Neurology 2005, 64:1508–1513.

    Article  PubMed  CAS  Google Scholar 

  24. Volker W, Ringelstein EB, Dittrich R, et al.: Morphometric analysis of collagen fibrils in skin of patients with spontaneous cervical artery dissection. J Neurol Neurosurg Psychiatry 2008, 79:1007–1012.

    Article  PubMed  CAS  Google Scholar 

  25. Baumgartner RW, Lienhardt B, Mosso M, et al.: Spontaneous and endothelial-independent vasodilation are impaired in patients with spontaneous carotid dissection: a case-control study. Stroke 2007, 38:405–406.

    Article  PubMed  Google Scholar 

  26. Baracchini C, Tonello S, Vitaliani R, et al.: Vasomotion in multiple spontaneous cervical artery dissections. Stroke 2008, 39:1148–1151.

    Article  PubMed  Google Scholar 

  27. Rubinstein SM, Peerdeman SM, van Tulder MW, et al.: A systematic review of the risk factors for cervical artery dissection. Stroke 2005, 36:1575–1580.

    Article  PubMed  Google Scholar 

  28. Schievink WI, Mokri B, Piepgras DG, Kuiper JD: Recurrent spontaneous arterial dissections: risk in familial versus nonfamilial disease. Stroke 1996, 27:622–624.

    PubMed  CAS  Google Scholar 

  29. Martin JJ, Hausser I, Lyrer P et al.: Familial cervical artery dissections: clinical, morphologic, and genetic studies. Stroke 2006, 37:2924–2929.

    Article  PubMed  Google Scholar 

  30. Benninger DH, Georgiadis D, Gandjour J, Baumgartner RW: Accuracy of color duplex ultrasound diagnosis of spontaneous carotid dissection causing ischemia. Stroke 2006, 37:377–381.

    Article  PubMed  Google Scholar 

  31. Kirsch E, Kaim A, Engelter S, et al.: MR angiography in internal carotid artery dissection: improvement of diagnosis by selective demonstration of the intramural haematoma. Neuroradiology 1998, 40:704–709.

    Article  PubMed  CAS  Google Scholar 

  32. Wolpert SM, Caplan LR: Current role of cerebral angiography in the diagnosis of cerebrovascular diseases. AJR Am J Roentgenol 1992, 159:191–197.

    PubMed  CAS  Google Scholar 

  33. Okudera T: The current role of cerebral angiography in diagnosis of cerebrovascular disease [in Japanese]. Rinsho Shinkeigaku 1995, 35:1569–1571.

    PubMed  CAS  Google Scholar 

  34. Freeman RK, Swegle J, Sise MJ: The surgical complications of Ehlers-Danlos syndrome. Am Surg 1996, 62:869–873.

    PubMed  CAS  Google Scholar 

  35. North KN, Whiteman DA, Pepin MG, Byers PH: Cerebrovascular complications in Ehlers-Danlos syndrome type IV. Ann Neurol 1995, 38:960–964.

    Article  PubMed  CAS  Google Scholar 

  36. Zilocchi M, Macedo TA, Oderich GS, et al.: Vascular Ehlers-Danlos syndrome: imaging findings. AJR Am J Roentgenol 2007, 189:712–719.

    Article  PubMed  Google Scholar 

  37. Touze E, Gauvrit JY, Meder JF, Mas JL: Prognosis of cervical artery dissection. Front Neurol Neurosci 2005, 20:129–139.

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  39. de Bray JM, Penisson-Besnier I, Dubas F, Emile J: Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis. J Neurol Neurosurg Psychiatry 1997, 63:46–51.

    Article  PubMed  Google Scholar 

  40. Pelkonen O, Tikkakoski T, Leinonen S, et al.: Extracranial internal carotid and vertebral artery dissections: angiographic spectrum, course and prognosis. Neuroradiology 2003, 45:71–77.

    PubMed  CAS  Google Scholar 

  41. Touze E, Gauvrit JY, Moulin T, et al.: Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. Neurology 2003, 61):1347–1351.

    PubMed  CAS  Google Scholar 

  42. Schievink WI, Mokri B, Piepgras DG: Spontaneous dissections of cervicocephalic arteries in childhood and adolescence. Neurology 1994, 44:1607–1612.

    PubMed  CAS  Google Scholar 

  43. Sengelhoff C, Nebelsieck J, Nassenstein I, et al.: Neurosonographical follow-up in patients with spontaneous cervical artery dissection. Neurol Res 2008, 30:687–689.

    Article  PubMed  Google Scholar 

  44. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B: Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006, 67:1809–1812.

    Article  PubMed  Google Scholar 

  45. de Bray JM, Marc G, Pautot V, et al.: Fibromuscular dysplasia may herald symptomatic recurrence of cervical artery dissection. Cerebrovasc Dis 2007, 23:448–452.

    Article  PubMed  Google Scholar 

  46. Schievink WI, Mokri B, O’Fallon WM: Recurrent spontaneous cervical-artery dissection. N Engl J Med 1994, 330:393–397.

    Article  PubMed  CAS  Google Scholar 

  47. Beletsky V, Nadareishvili Z, Lynch J, et al.: Cervical arterial dissection: time for a therapeutic trial? Stroke 2003, 34:2856–2860.

    Article  PubMed  Google Scholar 

  48. Norris JW: Extracranial arterial dissection: anticoagulation is the treatment of choice: for. Stroke 2005, 36:2041–2042.

    Article  PubMed  Google Scholar 

  49. Engelter S, Lyrer P: Antithrombotic therapy for cervical artery dissection. Front Neurol Neurosci 2005, 20:147–159.

    Article  PubMed  CAS  Google Scholar 

  50. Lyrer PA: Extracranial arterial dissection: anticoagulation is the treatment of choice: against. Stroke 2005, 36:2042–2043.

    Article  PubMed  CAS  Google Scholar 

  51. Lyrer P, Engelter S: Antithrombotic drugs for carotid artery dissection. Cochrane Database Syst Rev 2003, CD000255.

  52. Bonati LH, Wetzel SG, Gandjour J, et al.: Diffusion-weighted imaging in stroke attributable to internal carotid artery dissection: the significance of vessel patency. Stroke 2008, 39:483–485.

    Article  PubMed  Google Scholar 

  53. Dreier JP, Lurtzing F, Kappmeier M, et al.: Delayed occlusion after internal carotid artery dissection under heparin. Cerebrovasc Dis 2004, 18:296–303.

    Article  PubMed  CAS  Google Scholar 

  54. Mohr JP, Thompson JL, Lazar RM, et al.: A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001, 345:1444–1451.

    Article  PubMed  CAS  Google Scholar 

  55. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al.: Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005, 352:1305–1316.

    Article  PubMed  CAS  Google Scholar 

  56. Diener HC, Bogousslavsky J, Brass LM, et al.: Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004, 364:331–337.

    Article  PubMed  CAS  Google Scholar 

  57. Engelter ST, Brandt T, Debette S, et al.: Antiplatelets versus anticoagulation in cervical artery dissection. Stroke 2007, 38:2605–2611.

    Article  PubMed  Google Scholar 

  58. Georgiadis D, Lanczik O, Schwab S, et al.: IV thrombolysis in patients with acute stroke due to spontaneous carotid dissection. Neurology 2005, 64:1612–1614.

    Article  PubMed  CAS  Google Scholar 

  59. Edgell RC, Abou-Chebl A, Yadav JS: Endovascular management of spontaneous carotid artery dissection. J Vasc Surg 2005, 42:854–860.

    Article  PubMed  Google Scholar 

  60. Georgiadis D, Baumgartner RW: Thrombolysis in cervical artery dissection. Front Neurol Neurosci 2005, 20:140–146.

    Article  PubMed  Google Scholar 

  61. Yu W, Binder D, Foster-Barber A, et al.: Endovascular embolectomy of acute basilar artery occlusion. Neurology 2003, 61:1421–1423.

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  63. Schievink WI, Mokri B, Piepgras DG: Angiographic frequency of saccular intracranial aneurysms in patients with spontaneous cervical artery dissection. J Neurosurg 1992, 76:62–66.

    Article  PubMed  CAS  Google Scholar 

  64. Ohkuma H, Suzuki S, Ogane K: Dissecting aneurysms of intracranial carotid circulation. Stroke 2002, 33:941–947.

    Article  PubMed  Google Scholar 

  65. Schievink WI, Mokri B, Piepgras DG, Gittenberger-de Groot AC: Intracranial aneurysms and cervicocephalic arterial dissections associated with congenital heart disease. Neurosurgery 1996, 39:685–689.

    Article  PubMed  CAS  Google Scholar 

  66. El-Sabrout R, Cooley DA: Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg 2000, 31:702–712.

    Article  PubMed  CAS  Google Scholar 

  67. Muller BT, Luther B, Hort W, et al.: Surgical treatment of 50 carotid dissections: indications and results. J Vasc Surg 2000, 31:980–988.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  69. Kurata A, Oka H, Ohmomo T et al.: Successful stent placement for cervical artery dissection associated with the Ehlers-Danlos syndrome. Case report and review of the literature. J Neurosurg 2003, 99:1077–1081.

    PubMed  Google Scholar 

  70. Lavallee PC, Mazighi M, Saint-Maurice JP, et al.: Stent-assisted endovascular thrombolysis versus intravenous thrombolysis in internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion. Stroke 2007, 38:2270–2274.

    Article  PubMed  Google Scholar 

  71. Lylyk P, Cohen JE, Ceratto R, et al.: Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections. AJNR Am J Neuroradiol 2002, 23:430–436.

    PubMed  Google Scholar 

  72. Sampognaro G, Turgut T, Conners JJ 3rd, et al.: Intraarterial thrombolysis in a patient presenting with an ischemic stroke due to spontaneous internal carotid artery dissection. Catheter Cardiovasc Interv 1999, 48:312–315.

    Article  PubMed  CAS  Google Scholar 

  73. Willing SJ, Skidmore F, Donaldson J, et al.: Treatment of acute intracranial vertebrobasilar dissection with angioplasty and stent placement: report of two cases. AJNR Am J Neuroradiol 2003, 24:985–989.

    PubMed  Google Scholar 

  74. Malek AM, Higashida RT, Phatouros CC, et al.: Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty. AJNR Am J Neuroradiol 2000, 21:1280–1292.

    PubMed  CAS  Google Scholar 

  75. Albuquerque FC, Han PP, Spetzler RF, et al.: Carotid dissection: technical factors affecting endovascular therapy. Can J Neurol Sci 2002, 29:54–60.

    PubMed  Google Scholar 

  76. Liu AY, Paulsen RD, Marcellus ML, et al.: Long-term outcomes after carotid stent placement treatment of carotid artery dissection. Neurosurgery 1999, 45:1368–1373.

    Article  PubMed  CAS  Google Scholar 

  77. Cohen JE, Leker RR, Gotkine M, et al.: Emergent stenting to treat patients with carotid artery dissection: clinically and radiologically directed therapeutic decision making. Stroke 2003, 34:e254–e257.

    Article  PubMed  Google Scholar 

  78. Benninger DH, Gandjour J, Georgiadis D, et al.: Benign long-term outcome of conservatively treated cervical aneurysms due to carotid dissection. Neurology 2007, 69:486–487.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alex Abou-Chebl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abou-Chebl, A. Cervical artery dissection. Curr Treat Options Cardio Med 11, 167–175 (2009). https://doi.org/10.1007/s11936-009-0017-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-009-0017-5

Keywords

Navigation