• However, carotid and vertebral dissections are still underrecognized despite their distinct clinical and radiologic manifestations. (medscape.com)
  • In extracranial carotid and vertebral dissections, hemorrhage into the medial-adventitial layers occurs most commonly. (medscape.com)
  • In intracranial carotid and vertebral dissections, subintimal tears occur more commonly, leading to formation of intramural hematomas that protrude inward and narrow the vessel lumen. (medscape.com)
  • Cervical artery dissection is a major cause of ischemic stroke in young adults, but the diagnosis can be difficult to make because patients may present with benign symptoms such as headache, neck pain, or dizziness. (medscape.com)
  • Dissection of the cervical and intracranial vessels is an uncommon but increasingly recognized condition. (medscape.com)
  • While some studies have reported that males and females are affected equally in extracranial carotid dissections, the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) group reported that cervical artery dissection was more common in men and men were older at onset. (medscape.com)
  • Thrombolysis in cervical artery dissection--data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database. (medscape.com)
  • Dissection is usually accompanied by hemorrhage into the arterial wall, which creates, as demonstrated in the first image below, a blind pouch or (uncommonly) a parallel subintimal second channel. (medscape.com)
  • B, Subadventitial dissection represents hemorrhage between the media and the adventitia. (medscape.com)
  • The hallmark of dissection is hemorrhage within the vessel wall. (medscape.com)
  • Arterial dissection is characterized by an intimal tear that results in an intramural hematoma and subsequent splitting of vessel wall layers, causing stenosis or occlusion and potentially aneurysmal dilatation of the vessel. (medscape.com)
  • Dissection occurs when blood extrudes into the connective tissue framework of a vessel wall, causing separation of the natural vessel layers. (medscape.com)
  • Most ischemic symptoms (85-95%) are caused by emboli from the site of the dissection, while the remainder are due to vessel narrowing with hemodynamic insufficiency (5-15%) or a combination of both. (medscape.com)
  • Morbidity and mortality of cervicocephalic dissections vary according to the vessel and location of the dissection. (medscape.com)
  • Extracranial vertebral artery dissections and multiple vessel dissections are more common in women than in men. (medscape.com)
  • In general, such dissections can be categorized as traumatic or spontaneous. (medscape.com)
  • Spontaneous dissections are those in which no definitive precipitating factor is recognized. (medscape.com)
  • Hospital-based series suggest that cervicocephalic dissections are responsible for 1-2.5% of ischemic strokes in the general population and for 5-20% of strokes in individuals younger than 45 years. (medscape.com)
  • The term dissection refers primarily to an elevation or separation of the intimal lining of an artery from the subjacent media and, less frequently, to separation of the media from the adventitia. (medscape.com)
  • Recognizing a dissection early is essential, because prompt anticoagulant and/or antiplatelet therapy and endovascular repair greatly minimize the patient's risk of infarction, neurologic disability, and death. (medscape.com)
  • Cervicocephalic dissections may occur spontaneously or secondary to major or minor trauma. (medscape.com)
  • Elevation of an intimal flap is not a common finding associated with this type of dissection. (medscape.com)
  • Intracranial dissections are more common in younger males than in females. (medscape.com)
  • A, Tear and elevation of the intima from the wall of the artery, resulting in luminal stenosis. (medscape.com)
  • The artery may become dilated as a result of thickening of the arterial wall, with some degree of luminal narrowing. (medscape.com)
  • Chronic subadventitial dissection of the right internal carotid artery. (medscape.com)
  • However, carotid and vertebral dissections are still underrecognized despite their distinct clinical and radiologic manifestations. (medscape.com)
  • The internal carotid artery is affected more often than the vertebral artery. (medscape.com)
  • Internal carotid artery dissection can lead to thrombus formation and the risk for distal embolization, whereas arterial narrowing with stroke due to inadequate blood flow is a less common mechanism of ischemia. (medscape.com)
  • Anhidrosis is not present because sweat fibers run with the uninvolved external carotid artery. (medscape.com)
  • A highly suggestive constellation of signs and symptoms frequently seen with internal carotid artery dissection is Horner syndrome . (medscape.com)
  • Oculosympathetic palsy in the form of Horner syndrome has long been recognized as a typical manifestation of internal carotid artery dissection, although it is found in fewer than half of patients. (medscape.com)
  • The most typical signs and symptoms of internal carotid artery dissection are neck pain and/or a partial Horner syndrome. (medscape.com)
  • However, the best method to diagnose an internal carotid artery dissection is a combination of CTA and magnetic resonance angiography (MRA) with fat-suppressed T1 images. (medscape.com)
  • [ 1 , 5 , 6 ] CTA and MRA are replacing conventional angiography in the diagnosis of internal carotid and vertebral artery dissection because the resolution and accuracy of CTA and MRA are similar to that of angiography. (medscape.com)
  • A review comparing MRI/MRA with CTA showed the performance characteristics to be very similar for the diagnosis of carotid artery dissection. (medscape.com)
  • In patients with severe concomitant carotid artery disease, this condition may contribute to cerebral hypoperfusion in the setting of subclavian steal. (medscape.com)
  • Proximal common carotid artery disease may be best approached angiographically for angioplasty or stenting. (medscape.com)
  • The subclavian artery can also be transposed to a new origin on the side of the common carotid artery. (medscape.com)
  • The dissection required is more extensive than that required for carotid-subclavian bypass, and care must be taken to avoid injury to the thoracic duct on the left side. (medscape.com)
  • A, Tear and elevation of the intima from the wall of the artery, resulting in luminal stenosis. (medscape.com)
  • In general, such dissections can be categorized as traumatic or spontaneous. (medscape.com)
  • If a thrombus is found in both the true and the false lumens, the dissection is defined as an occlusion dissection. (medscape.com)
  • However, if the cause of subclavian steal syndrome is determined to be atherosclerotic stenosis or occlusion of the proximal subclavian artery, patients should be treated with lifelong antiplatelet therapy to reduce the risk of associated myocardial infarction, stroke, and other vascular causes of death. (medscape.com)
  • Surgical or interventional treatment should not be offered to treat subclavian artery stenosis or occlusion in the absence of symptoms related to either cerebral or ipsilateral arm ischemia. (medscape.com)
  • Because the occlusive lesions in the proximal left subclavian artery develop as an extension of plaque from the aortic arch, partial occlusion of the arch must be performed to ensure that the entire lesion is effectively removed. (medscape.com)
  • Spontaneous dissections are those in which no definitive precipitating factor is recognized. (medscape.com)
  • Traumatic dissections are linked to direct neck trauma or injury , whereas spontaneous dissections may be secondary to predisposing factors, such as fibromuscular dysplasia , Ehlers-Danlos syndrome , cystic medial necrosis, or Marfan syndrome . (medscape.com)
  • The artery may become dilated as a result of thickening of the arterial wall, with some degree of luminal narrowing. (medscape.com)
  • Additionally, MRI/MRA is superior to conventional angiography in diagnosing dissections without associated luminal abnormalities. (medscape.com)
  • This angiogram shows a small pseudoaneurysm and a small intimal dissection with an elevated intimal flap that is just proximal to the subadventitial dissection. (medscape.com)
  • Recognizing a dissection early is essential, because prompt anticoagulant and/or antiplatelet therapy and endovascular repair greatly minimize the patient's risk of infarction, neurologic disability, and death. (medscape.com)
  • Vertebral artery dissection (VAD) is a relatively rare but increasingly recognized cause of stroke in patients younger than 45 years. (medscape.com)
  • The term dissection refers primarily to an elevation or separation of the intimal lining of an artery from the subjacent media and, less frequently, to separation of the media from the adventitia. (medscape.com)
  • Elevation of an intimal flap is not a common finding associated with this type of dissection. (medscape.com)
  • This means that the hematoma is located between the intimal and medial layers of the artery. (medscape.com)
  • Dissection is usually accompanied by hemorrhage into the arterial wall, which creates, as demonstrated in the first image below, a blind pouch or (uncommonly) a parallel subintimal second channel. (medscape.com)
  • These conditions cause an abnormal, weakened arterial wall, thus predisposing patients to arterial dissection. (medscape.com)
  • ultrasonography may have a role in the initial diagnosis of dissections if CT-A or MRA are unavailable. (medscape.com)
  • Dissection normally occurs in the extracranial segment of the epiaortic vessels. (medscape.com)
  • However, if either vertebrobasilar symptoms or exercise-induced arm pain occurs, a search for subclavian artery occlusive disease should be undertaken. (medscape.com)
  • Traumatic dissection is the result of either external mechanical injury, such as a penetrating or blunt trauma, or trivial trauma that is related to a movement or abrupt change in head position. (medscape.com)
  • This may be followed by an ischemic event ipsilateral to the ocular signs, with somatosensory and/or motor deficits contralateral to ocular signs as a consequence of distal embolization to the intracerebral arteries. (medscape.com)