Carotid Artery Dissection

It refers to a tear in one of the four carotid arteries in the body. It is considered to be one of the most reasons for ischemic stroke in young adults.

The carotid artery is a prime blood vessel which passes from the aorta into the neck beside the trachea and just above the heart. The human body comprises of four carotid arteries. Two arteries lie on each side of the neck and are known as the internal and external carotid. These arteries transmit blood from the aorta to the parts of the head such as eyes, brain, facial muscles and other structures. In patients affected by Carotid Artery Dissection (CAD), one of these arteries suffers a rupture – leading to a stroke.

Carotid Artery Dissection Causes

Carotid dissection occurs due to a tear in the wall of the artery, which makes blood leak in between the layers and separate them. This results in breakdown of the layers which tears the walls.

The carotid arteries can break down for various reasons, such as:

Marfan syndrome

This is a disease of genetic connective tissue. It places individuals at high risk of developing carotid artery dissection. In this condition, the dissection is spontaneous as it takes place without any trauma to the head or neck.

Trauma or injury

The dissection can also occur if an individual receives an injury in the neck as in the case of a sudden fall or car accident or during exercise or in sports. This is found to be more common a reason for development of carotid artery dissection according to the studies by medical experts.

Other causes

Various other factors are responsible for this dissection. These include:

  • Excess smoking, which maximizes the risk of carotid dissection
  • High blood pressure
  • Coughing, sneezing or vomiting hard with pressure
  • Whiplash injuries
  • Neck tension while washing hair in salon
  • Extreme neck extension during performance of yoga
  • Neck extension while receiving air mouth-to-mouth during cardiopulmonary resuscitation

How Does Carotid Dissection Occur?

Carotid artery dissection is a tear in one of the layers of the artery wall. Blood leaks out through this gap and spreads between the layers of the wall. Once blood starts accumulating in the area of the tear it begins to form a clot, which again hinders the flow of blood through the artery. If the clot turns large enough to completely stop the blood flow, it would eventually lead to a cardiac stroke.

In affected individual, pieces of the clot also break off and move up through the bloodstream. They get trapped in the smaller blood vessels in the brain which disrupts the blood flow to a region of the brain and leads to stroke. Artery may get swollen where the blood is getting accumulated. This swollen artery can lead to stroke as it presses on the brain structures around.

Carotid Artery Dissection Symptoms

The signs and symptoms of CAD can be separated into two categories – Ischaemic and Non-ischaemic.

Ischaemic symptoms

  • Ischaemic stroke
  • Vision loss (transient)

Non-Ischaemic symptoms

  • Pupil of reduced size
  • Droopy upper eyelid
  • Headache
  • Pain in the neck

Other symptoms

Some other symptoms experienced by affected people include:

  • Double vision
  • Pain in the face
  • Pain on both sides of the neck
  • Dizzyness
  • Sudden change in the sense of taste
  • Pain in the eyes
  • Ringing sensation in the ears
  • Numbness in the neck muscles and face on one side
  • Speech difficulties
  • Swelling in the neck
  • Migraine like symptoms

Carotid Artery Dissection Diagnosis

The following imaging techniques have been found to be very helpful in properly diagnosing this condition.

CTA

Helical computed tomography angiography is the first choice for patients who suffer a trauma. It is a non-invasive imaging which makes use of computed tomography and contrasting color material to provide a clear 3-dimensional image of the arteries on the computer screen. This technique can also produce cross-sectional images of the blood vessel which also shows dissection of the carotid arteries and its characteristics.

MRA

Magnetic resonance angiography offers a very accurate method. It is non invasive technique which uses magnetic field and radio waves to project images of the carotid arteries.

Doppler Ultrasonography (DUS)

This is another popular tool used in detecting CAD. It has the ability to identify abnormal blood flow in a dissected artery. It also produces the results very fast and is non invasive – which is an added advantage.

These imaging studies also show possible damages in the brain tissues due to the dissection of the carotid artery.

Carotid Artery Dissection Treatment

The primary aim of CAD management is to treat the symptoms such as preventing stroke. Some of the treatment options for CAD include:

Anti-platelet Therapy

There are drugs such as aspirin, clopidogrel and ticlopidine which are administered with or without warfarin. These drugs do not allow the blood to clot.

Anti-coagulant Therapy

This therapy should be started when a thrombus is observed. This medication issued to thin the blood and prevent it from clotting. Heparin is administered intravenously, after which warfarin is given orally.  These medicines help in preventing a stroke. They are supposed to be continued for 3-6 months or more depending on the condition of the patient.

Patients who are unable to take either of the above medications or continue showing symptoms even after intake of warfarin such as weakness or vision problems will have to be treated through other procedures.

Angioplasty

This is a minimally invasive treatment done through the blood vessels. It involves placing a stent or mesh like device which will hold the artery open. Two endovascular techniques are used to treat this carotid dissection.

Other surgical options include:

  • Neurosurgery
  • Vascular surgery
  • Interventional radiology
  • Neurology

However, before opting for these procedures it is advisable to consult more than one surgeon. Consultation is required especially in previously existing cases of:

  • Traumatic brain injury
  • Multiple traumas
  • Upper gastrointestinal bleeding
  • Brain lesion

Patients after treatment must be observed closely for any kind of neurologic symptoms or hemorrhagic side effects of antithrombotic medicines. Complications may also take place later along with hemorrhagic stroke.

Carotid Artery Dissection Prognosis

More than half of the patients who have had carotid artery dissection are noticed to suffer from neurological problems throughout their life. 1 percent of the patients have high chances of developing a tear over time within a span of 10 years. Young patients are more prone to have a recurrence but respond better to treatment. Patients who have suffered spontaneous CAD have a high mortality rate depending on the severity of the injury. A lot of patients have a high chance of developing a stroke. However, most sufferers make a speedy recovery after being treated for spontaneous carotid artery dissection.

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