Cervical artery dissection: presentation and treatment

Cervical artery dissection (CeAD) is a rare condition whereby a tear occurs in the intimal layer of the artery wall. This condition can determine stroke, peripheral symptoms or can be asymptomatic. Vascular surgeons are often involved in the treatment of this pathology and the present paper aims to overview the actual knowledge on this topic. Clinical studies and randomized trials were screened and analyzed through PubMed to report the incidence, the clinical manifestations and the treatment options of CeAD. CeAD involving extracranial internal carotid artery is most frequently involved (80%) rather than vertebral artery (15%) or carotid artery in association with vertebral artery (5%). Internal carotid dissection occurs in all age group and it is responsible for 2.5% of all strokes, and 40% of stroke in patients older than 50 years. Carotid artery dissection typically begins with local symptoms, such as a sudden onset of unilateral and constant headache or an ipsilateral neck pain or a partial Horner’s syndrome, followed by retinal or cerebral ischemia. Stroke associated with CeAD are present in 50-60% of symptomatic cases, even if many of CeAD are asymptomatic and therefore the real incidence of stroke associated with CeAD is difficult to establish. The risk of recurrent stroke after carotid artery dissection is less than 3%. Anticoagulant or antiplatelet therapy are both associated with low-rate of symptoms recurrence (1-3%) at the follow-up. Surgical or endovascular therapy can be considered for patients with symptoms recurrence without benefit from medical therapy. CeAD is a possible cause of stroke, and it should be carefully investigated, particularly in young patients, in order to deliver an adequate therapeutic approach.