Spontaneous carotid and vertebral artery dissection

Aneesh B Singhal MD (Dr. Singhal of Harvard Medical School received consutling fees from Biogen, Dock Technologies, and Medicolegal for consulting, owns stock in Biogen, and receives research support from Boehringer Ingelheim.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released April 10, 1995; last updated December 1, 2015; expires December 1, 2018

This article includes discussion of spontaneous carotid and vertebral artery dissection, common carotid artery dissection, extracranial internal carotid artery dissection, and intracranial internal carotid artery dissection. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Cerebral artery dissection is the most common cause of stroke in young adults. Recent studies provide insights into the pathophysiology, risk factors, management, and outcome of this condition. In this article, the author provides a comprehensive review of spontaneous (nontraumatic) carotid and vertebral artery dissections.

Historical note and terminology

The first description of spontaneous dissection of the cervical arteries dates back to 1915 (Turnball 1915). However, in 1959, Anderson and Schechter were the first to clearly document a case of spontaneous dissecting aneurysm of the internal carotid artery (Anderson and Schechter 1959; de Bray and Baumgartner 2005). The term "dissection," from the Latin verb disseco, implied the separation of anatomic structures along the natural lines by tearing of the connective tissue framework. As it is applied to vascular pathology, it relates to the separation of the different layers that constitute the arterial wall. This process can occur either spontaneously or following blunt trauma to the vessel. Sub-intimal dissections can cause lumen stenosis, and sub-adventitial dissections can cause aneurysmal dilatation. Strictly speaking, the lesion of dissection is a “dissecting aneurysm” and includes layers of the normal vessel wall (Guillon et al 1999). The term “pseudoaneurysm” is often used incorrectly for this same purpose, but this term refers to lesions that do not include components of the normal vessel wall. An example of pseudoaneurysm is a posttraumatic event where the vessel wall is severed and adjacent connective tissue maintains a lumen.

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