Carotid Artery Dissection

What is carotid artery dissection?

The carotid arteries are a pair of important blood vessels in your neck that supply blood to your brain. An arterial dissection is when a tear in the layers of an arterial wall allows blood to flow between the layers of the artery. This can happen in a variety of arteries in your body.

A carotid artery dissection is when there's a tear in the arterial wall in your carotid arteries. While there is a tear in the walls of the artery, your blood remains within your blood vessel and doesn’t result in bleeding outside of the blood vessel. But blood within the walls of your artery can compromise the flow of blood, leading to a slowing or complete blockage of blood flow to your brain.

Sometimes pain is the only sign of carotid artery dissection, but it also can lead to serious complications such as:

• Brain ischemia (not enough blood to your brain).
• Subarachnoid hemorrhage (bleeding in the space that surrounds your brain).
• Stroke.
• Transient ischemic attack, also called TIA or mini-stroke.

It’s crucial to get a timely diagnosis and treatment to prevent complications or death.

What’s the difference between carotid artery dissection and cervical artery dissection?

There are four main arteries in your neck: two carotid arteries and two vertebral arteries. Collectively they’re called the cervical arteries. A cervical artery dissection is a separation or tear in the wall of any of these four arteries.

A carotid artery dissection is a tear specifically in one of the two carotid arteries. It’s a type of cervical artery dissection.

Who might get carotid artery dissection?

Carotid artery dissection can happen to anyone at any age, but it’s more common in people in their 40s or 50s.

How common is carotid dissection?

This condition isn’t common, occurring in only 2 or 3 people per 100,000.

What causes carotid artery dissection?

• Car accident.
• Chiropractic manipulation.
• Neck extension and rotation for a long period of time, such as having a lengthy phone conversation with your neck angled.
• Sports-related accident.
• Forceful coughing or nose blowing.

What are the risk factors for carotid artery dissection?

Risk factors include:

• Connective tissue disorders, such as Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta and fibromuscular dysplasia.
• Family history of dissection.
• High blood pressure (hypertension).
• Hyperhomocysteinemia, abnormally high levels of homocysteine in the blood.
• Injury or trauma to your neck.
• Migraine headaches.
• Smoking or using tobacco products.

What are the symptoms of carotid artery dissection?

Carotid artery dissection symptoms vary widely, from no signs to sudden stroke. Signs may include:

• Eye pain.
• Facial pain.
• Headache.
• Horner’s syndrome, with symptoms on one side of the face (sagging eyelid, lack of sweat, and one smaller pupil).
• Neck pain.
• Neurologic deficits, such as abnormal reflexes, difficulty speaking, memory problems or loss of balance.
• Stroke-like symptoms, such as sudden numbness or weakness, slurred speech or confusion.

How is carotid artery dissection diagnosed?

Because symptoms vary so widely, carotid artery dissection can be difficult to diagnose.

For diagnosis, a healthcare provider may need the following:

• Physical exam.
• Medical history, including 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.

How is carotid artery dissection treated?

Your healthcare provider will recommend treatment depending on several factors, such as:

• Cause of dissection.
• Other medical conditions you have.
• Whether a stroke has occurred.
• Whether you’re experiencing bleeding.

Treatment may include:

• Anticoagulants, which are medications that break down blood clots or prevent new clots.
• Antiplatelets, which are medications that stop blood cells called platelets from sticking together and forming blood clots.
• A procedure called angioplasty to open the artery, sometimes with stenting to keep it open (used sparingly).
• Surgery to remove the dissection or reroute blood flow around the dissection (also used sparingly and often as a last resort).

What is the outlook with carotid artery dissection?

The prognosis with carotid artery dissection varies widely, depending on its cause and severity. Some people don’t require treatment, but others experience serious, life-threatening complications.

Can a carotid artery dissection heal itself?

A carotid artery dissection may heal itself over time. Your healthcare provider might monitor it to determine whether it gets worse and to detect any possible complications early.

Does carotid artery dissection usually return after treatment?

A carotid artery dissection doesn’t usually recur (come back) after treatment. The recurrence rate within one year is from zero up to 10%.

How can I reduce my risk of carotid artery dissection?

If you have a condition associated with carotid artery dissection, it’s important to follow your healthcare provider's instructions. This can help you prevent dissection or detect it early.

A healthy lifestyle can help control your blood pressure and minimize the risk of carotid artery dissection. It’s important to:

• Avoid or quit smoking and using tobacco products.
• Eat nutritious foods.
• Exercise regularly.
• Maintain a healthy weight.
• Avoid activities with a high risk for blunt trauma.

When should I seek medical attention for carotid artery dissection?

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