Carotid Artery Dissection
Carotid artery dissection occurs when there's a tear in the layers of the arterial wall within the carotid arteries, which are the essential blood vessels in your neck that supply blood to the brain. This tear allows blood to flow between the layers of the artery, which can disrupt normal blood flow to the brain. Although the tear doesn’t cause bleeding outside the blood vessel, it can still lead to a reduction or complete blockage of blood flow to the brain. When this condition specifically occurs in the carotid arteries, it is called carotid artery dissection. Prompt diagnosis and treatment are critical to prevent serious complications or fatalities.
Carotid Artery Dissection vs. Cervical Artery Dissection
In the neck, there are four primary arteries—two carotid arteries and two vertebral arteries—collectively referred to as cervical arteries. A cervical artery dissection involves a tear in any of these four arteries. Carotid artery dissection is a specific type of cervical artery dissection that occurs when there is a tear within one of the carotid arteries.
Who is at Risk of Experiencing Carotid Artery Dissection?
Carotid artery dissection can affect individuals of any age but is more commonly observed in people in their 40s or 50s.
How Common is Carotid Dissection?
Carotid artery dissection is relatively uncommon, occurring in about 2 to 3 individuals per 100,000.
Symptoms and Causes
What Leads to Carotid Artery Dissection?
Several factors can trigger carotid artery dissection, including:
- Car accidents
- Chiropractic manipulation
- Prolonged neck extension and rotation, such as during lengthy phone conversations
- Sports-related accidents
- Forceful coughing or intense nose blowing
What Factors Contribute to the Risk of Carotid Artery Dissection?
Several risk factors increase the likelihood of carotid artery dissection, including:
- Connective tissue disorders like Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta, and fibromuscular dysplasia
- A family history of dissection
- High blood pressure (hypertension)
- Hyperhomocysteinemia (abnormally high levels of homocysteine in the bloodstream)
- Neck injury or trauma
- Migraine headaches
- Smoking or tobacco use
What Are the Symptoms of Carotid Artery Dissection?
Symptoms can range from being entirely asymptomatic to suddenly developing stroke-like signs. Possible symptoms include:
- Eye pain
- Facial pain
- Headache
- Horner’s syndrome (drooping eyelid, lack of sweat, and a smaller pupil on one side of the face)
- Neck pain
- Neurologic deficits (abnormal reflexes, difficulty speaking, memory issues, or loss of balance)
- Stroke-like symptoms (sudden numbness or weakness, slurred speech, or confusion)
Diagnosis and Tests
How is Carotid Artery Dissection Diagnosed?
Diagnosing carotid artery dissection can be challenging due to the wide range of symptoms. A healthcare provider may use the following to make a diagnosis:
- Physical examination
- Medical history, including any prior neck injuries or medical conditions
- Ultrasound imaging to visualize the neck
- CT scan or MRI/MRA of the neck and/or brain
- Angiography
Management and Treatment
How is Carotid Artery Dissection Treated?
Treatment depends on factors such as the cause of the dissection, the patient’s medical conditions, whether a stroke has occurred, and whether bleeding is present. Treatment options may include:
- Anticoagulants (medications that dissolve blood clots or prevent new clots from forming)
- Antiplatelet drugs (prevent blood cells called platelets from clumping together and forming clots)
- Angioplasty (procedure to open the artery, sometimes with stenting to keep it open)
- Surgery to remove the dissection or redirect blood flow around the dissection (typically a last resort)
Prevention
How Can I Reduce My Risk of Carotid Artery Dissection?
To minimize the risk, individuals with conditions associated with this condition should follow their healthcare provider’s guidance. Maintaining a healthy lifestyle can help control blood pressure and reduce the risk. Key preventive measures include:
- Avoiding or quitting smoking and tobacco use
- Consuming a nutritious diet
- Engaging in regular physical exercise
- Maintaining a healthy weight
- Avoiding activities with a high risk of neck trauma
Outlook / Prognosis
What is the Outlook for Carotid Artery Dissection?
The prognosis varies widely, depending on its cause and severity. Some individuals may not require treatment, while others may face serious and life-threatening complications.
Can Carotid Artery Dissection Heal on Its Own?
In some cases, carotid artery dissection may heal naturally over time. Healthcare providers might monitor the condition to track its progression and detect potential complications early.
Is Carotid Artery Dissection Likely to Recur After Treatment?
Carotid artery dissection typically does not recur after treatment. The recurrence rate within one year is low, usually ranging from zero to 10%.
Living With
When Should I Seek Medical Attention for Carotid Artery Dissection?
It is essential to seek medical attention promptly if you experience any signs or symptoms associated with carotid artery dissection, particularly if you have risk factors or have recently suffered a neck injury. Early intervention is crucial.
