Carotid Artery Dissection

A carotid artery dissection is a tear in the wall of your carotid arteries, which supply blood to your brain. This rare tear in the artery’s layers allows blood to flow between the layers. Blood stays in your artery, but can flow more slowly or stop flowing to your brain. You may even have a complete blockage in your carotid artery.

When you don’t have enough blood flowing to your brain, you can have a stroke. This can happen even if you’re in your 40s, 30s or younger.

Because of the risk of stroke, you should seek treatment right away.

Symptoms of carotid artery dissection

Carotid artery dissection symptoms vary widely, from none at all to sudden stroke. Sometimes, pain (often around your eye) is the only symptom. Others may include:

• Pain in your eye, face, head or neck
• Sagging eyelid, lack of sweat, and one smaller pupil on one side of your face (Horner’s syndrome)
• Abnormal reflexes, difficulty speaking, memory problems or loss of balance
• Stroke-like symptoms, like sudden numbness or weakness, slurred speech or confusion

Carotid artery dissection causes

The cause of this condition is often unknown. But major or minor trauma to your neck can create a tear in your artery wall. Known causes of this condition include:

• Car accident
• Neck extension and rotation
• Sports-related accident
• Forceful coughing or nose blowing

Risk factors

Carotid dissection can happen to anyone at any age. But it’s more common in people in their 40s or 50s. Risk factors include:

• Connective tissue diseases
• Family history of dissection
• High blood pressure (hypertension)
• Hyperhomocysteinemia, abnormally high levels of homocysteine in your blood
• Injury or trauma to your neck
• Migraine headaches
• Smoking or using other tobacco products

How to lower your risk

If you have a condition that puts you at risk of carotid artery dissection, following your healthcare provider’s instructions can help. Your provider may be able to prevent dissection or detect it early.

A healthy lifestyle can help manage your blood pressure and minimize the risk of carotid artery dissection. Tips include:

• Avoid using tobacco products.
• Eat heart-healthy foods.
• Get regular physical activity.
• Maintain a healthy weight.
• Avoid activities with a high risk for blunt trauma.

Complications of this condition

A carotid dissection can make your artery narrow and cause a blood clot. You can have serious complications, like:

• Not enough blood to your brain (brain ischemia)
• Bleeding in the space that surrounds your brain (subarachnoid hemorrhage)
• Pooling of blood (pseudoaneurysm)
• Stroke
• Transient ischemic attack (TIA)

How doctors diagnose carotid artery dissection

Because symptoms vary so widely, dissection of a carotid artery can be difficult to diagnose. But a timely diagnosis and treatment can prevent complications or death.

For diagnosis, a healthcare provider may perform or order the following:

• Physical exam
• Medical history, like any other medical conditions or previous injury to your neck
• Ultrasound to take pictures inside your neck
• CT scan or MRI/MRA of your neck and/or brain
• Angiography

Your healthcare provider will recommend treatment depending on several factors, like other medical conditions you have and the cause of dissection. They’ll also consider whether you’ve had a stroke or are bleeding.

How is it treated?

Carotid artery dissection treatment to lower your stroke risk may include:

• Anticoagulants: Medications that break down blood clots or prevent new clots
• Antiplatelets: Medications that stop blood cells called platelets from sticking together and forming blood clots
• Angioplasty: A procedure to open the artery, sometimes with stenting to keep it open (used sparingly)
• Surgery: A procedure to remove the dissection or reroute blood flow around the dissection (also used sparingly and often when nothing else works)

When should I see my healthcare provider?

You should seek medical care right away for any signs of dissection of your carotid artery. This is especially important if you have any of the associated conditions or if you’ve recently injured your neck.

You can expect to have follow-up visits after treatment for this condition. Repeating imaging scans weeks or months later helps a provider see if the tear is healing. They’ll also want to know if the medicine you’re taking is working.

Questions to ask your provider may include:

• What caused this condition?
• What’s the best treatment for me?
• Is my family at risk for this, too?
• When should I have my first follow-up visit with you?

What can I expect if I have carotid artery dissection?

The prognosis (outlook) with this condition varies widely, depending on its cause and severity. Some people don’t need treatment. But others have serious, life-threatening complications. There’s a high risk of stroke. The outlook depends on whether you get a diagnosis before you have stroke symptoms.

A carotid artery dissection may heal itself over time. Your healthcare provider might monitor it to determine whether it’s getting worse and to detect any possible complications early. In one study, 6 out of 10 people with a dissection got full blood flow back in their carotid arteries. This is more likely if you have mild symptoms.

A carotid artery dissection doesn’t usually happen again after treatment.