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Dissection, Carotid and Vertebral Artery

Ian McDowell, DO Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Cervical artery dissection (CAD) is subcategorized into carotid artery dissection (CaAD) and vertebral artery dissection (VAD).

  • CAD accounts for 2–2.5% of all ischemic strokes.

EPIDEMIOLOGY

DIAGNOSIS

HISTORY

  • 2/3 CAD patients present as a TIA or stroke and some may present with both ischemic and local symptoms.

  • In spontaneous CaAD dissections, symptoms can be divided into local and those du...

TREATMENT

MEDICATION

First Line

Ischemic symptoms: 
  • IV thrombolysis (IVT) can provide recanalization of thrombus at the site of dissection or distal embolus and is safe in acute ischemic stroke with CAD ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Follow-up with a neurologist is highly recommended.

  • Repeat imaging is useful to guide further treatment decisions.

  • Anticoagulation should be managed as described in...

REFERENCES

1
Arnold M, Bousser MG, Fahrni G, et al. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke.  2006;37(10):2499–2503. [View Abstract on OvidMedline]
2
Verti...

CODES

ICD10

  • I77.71 Dissection of carotid artery

  • I77.74 Dissection of vertebral artery

  • I72.8 Aneurysm of other specified arteries

  • I72.0 Aneurysm of carotid artery

ICD9

  • 443.21 Dissection of carotid artery

  • 443....

CLINICAL PEARLS

  • CAD is composed of CaAD and VAD and is a major cause of stroke in the young.

  • A majority of patients have both ischemic and localized symptoms.

  • In the radiographic detection of CAD, CTA i...

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