What is carotid dissection?
Carotid artery dissection is a condition in which the inner layer (intima) of the carotid artery wall tears, allowing blood to enter between the wall layers and form an intramural hematoma. This hematoma can narrow or completely occlude the artery, reducing blood flow to the brain and potentially causing stroke.
Carotid dissection is one of the leading causes of ischemic stroke in young adults (under 50 years of age), accounting for 10-25% of strokes in this age group.
Causes
Spontaneous — occurs without clear trigger; may be associated with underlying connective tissue abnormalities (fibromuscular dysplasia, Ehlers-Danlos, Marfan syndrome).
Traumatic — after cervical trauma, chiropractic manipulation, sports injuries, motor vehicle accidents, or roller coaster rides.
Iatrogenic — rare complication of endovascular or surgical procedures on cervical vessels.
Symptoms
The classic triad includes: unilateral neck or head pain (most common symptom), Horner syndrome (drooping eyelid, constricted pupil, and decreased sweating on the affected side), and focal neurological signs due to stroke or TIA (weakness, speech difficulty, visual changes). Not all elements of the triad need to be present.
Diagnosis
- CT angiography — the most used emergency exam; shows the intramural hematoma and degree of luminal narrowing
- MRI/MR angiography with fat suppression — excellent for demonstrating the intramural hematoma (crescent sign)
- Cervical Doppler ultrasonography — initial screening, may show characteristic hemodynamic changes
- Catheter angiography — reserved for cases requiring endovascular treatment
Treatment
Medical treatment (majority of cases) — anticoagulation with heparin followed by warfarin, or antiplatelet therapy (aspirin/clopidogrel). The artery heals spontaneously in 60-80% of cases within 3-6 months.
Endovascular treatment — angioplasty with stenting is reserved for patients with recurrent ischemic events despite adequate medical therapy, pseudoaneurysm formation, or hemodynamically significant stenosis with inadequate healing.
If you have been diagnosed with carotid dissection, schedule a consultation for follow-up and treatment planning.
Perguntas Frequentes
What is carotid dissection?
It is a tear in the inner lining of the carotid artery wall, allowing blood to enter between the wall layers and form a hematoma that narrows or blocks the artery. It is one of the main causes of stroke in young adults.
What causes dissection?
It can be spontaneous, related to minor trauma (chiropractic manipulation, sports, roller coasters), or associated with connective tissue disorders. Often occurs in otherwise healthy young patients.
How is it treated?
Most cases are treated medically with anticoagulation or antiplatelet therapy. The artery heals spontaneously in the majority of cases. Endovascular treatment (stenting) is reserved for specific situations such as recurrent symptoms despite medical therapy.
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