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Cervical artery dissection

Background

Overview

Definition
Cervical artery dissection is a term that encompasses carotid and vertebral artery dissection.
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Pathophysiology
The majority of cervical artery dissections are spontaneous, while a smaller percentage of cases involve cervical trauma and cervical spine manipulations. A tear in the intima or rupture of the vasa vasorum with bleeding within the media may represent the initial precipitating factor.
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Disease course
Clinical manifestations of carotid artery dissections include neck pain, headache, and Horner's syndrome, which may be followed by retinal or cerebral ischemia in carotid artery dissections. Vertebral artery dissection presents with occipito-cervical pain, followed by posterior circulation ischemic symptoms including vertigo, dysarthria, visual field deficit, ataxia, and diplopia. Disease progression may lead to spinal cord infarction and stroke.
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Prognosis and risk of recurrence
Cervical artery dissection is associated with a mortality rate of 15-20% and is increased in patients with severe disability at presentation.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of cervical artery dissection are prepared by our editorial team based on guidelines from the American Heart Association (AHA/ASA 2021,2019), the European Stroke Organisation (ESO 2021), the Society for Cardiovascular Angiography and Interventions (SCAI/SNIS/SVM/AANS/ASNR/CNS/AANN/SVS/AHA/ACR/SAIP/ACC/ASA/SIR 2011), and the Society for Vascular Surgery (SVS 2011). ...
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Diagnostic investigations

Diagnostic imaging: as per AANN/AANS/ACC/ACR/AHA/ASA/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS 2011 guidelines, obtain contrast-enhanced CTA, MRA, or catheter-based contrast angiography for the diagnosis of cervical artery dissection.
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Medical management

Intravenous thrombolysis: as per ESO 2021 guidelines, consider performing IV thrombolysis with alteplase, if the standard inclusion/exclusion criteria are MET, in patients with symptomatic extracranial artery dissection with AIS within 4.5 hours of onset.
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Therapeutic procedures

Mechanical thrombectomy: as per ESO 2021 guidelines, consider performing mechanical thrombectomy in patients with AIS due to extracranial artery dissection and large vessel occlusion of the anterior circulation.
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