Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. A dissection forms when there’s a tear in one or more of its three tissue layers. It can affect blood flow, putting you at risk for life-threatening complications.
A dissection is a tear in one or more tissue layers that make up your vertebral artery. Vertebral artery dissection is a rare cause of stroke in older adults. It’s more common in people younger than 45.
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You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). They deliver oxygen-rich blood to your brain and spine.
The vertebral artery has three layers:
With a dissection, blood gets trapped between the intima and media. Blood that’s not moving can form a clot, creating a bulge that disrupts blood flow. It can also lead to swelling (dilation) of the artery.
In the most severe cases, vertebral artery dissection causes stroke:
In some people, vertebral artery dissection occurs for no known reason. You may face a higher risk of dissection if you have certain health conditions, including:
Injury can also cause dissection. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. It may also occur with sudden neck movements and trauma.
Activities and other situations that can lead to vertebral artery dissection include:
Cervical artery dissection includes tears in the arteries of your neck. These include vertebral and carotid arteries. Your two carotid arteries run along either side of your neck in the front. Dissection in either artery can disrupt blood flow and potentially cause a stroke.
Your chances of experiencing a stroke are low. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. Most of the time, ischemic stroke is due to atherosclerosis (thickening of the artery from other risk factors, such as smoking, high blood pressure, high cholesterol, diabetes).
However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. Up to 25% of stroke cases in this age group are due to vertebral artery dissection.
In earlier stages, you might not notice symptoms. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke.
Magnetic resonance angiography is the gold standard diagnostic test. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity.
Magnetic resonance angiography is a sophisticated test that’s not widely available. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. These are typically among the first tests people receive.
Sometimes, your healthcare provider may recommend conventional angiography. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. They’ll use contrast dye and X-ray-guided imaging to look at blood flow through the artery itself along with the extent of the dissection or vessel injury in real-time.
Most dissections heal on their own. To reduce the risk of blood clots, you may receive blood-thinning medications as a first-line therapy such as aspirin or aspirin-like medications (Plavix®), heparin infusion or warfarin tablets. If the dissection reaches your brain or there’s a hemorrhagic stroke, then blood thinners may not be safe. Your healthcare provider may recommend alternative treatments.
You may need a procedure. This option is also for people with hemorrhagic stroke.
Procedures for vertebral artery dissection include:
Most people make a full recovery. However, you may be at risk for future dissections. This risk decreases over time.
You’ll need regular monitoring until healthcare providers confirm that healing has taken place. Monitoring typically includes magnetic resonance angiography every three to six months. You may also need to continue taking a blood thinner during this time. Individuals facing a higher risk of future dissection will need follow-up care for many years.
You can still exercise but should avoid the following:
A note from Cleveland Clinic
Vertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. On rare occasions, this can lead to stroke. But timely treatment, typically blood thinners or a procedure, can save your life. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications.
Last reviewed by a Cleveland Clinic medical professional on 08/07/2022.
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