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Carotid Dissection
C. Douglas Phillips, MD, FACR; Rebecca S. Cornelius, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Carotid artery dissection (CAD), internal carotid artery dissection (ICAD)
          • Definitions

            • ICAD: Delamination of ICA wall by tear or rupture of intima allowing blood to gain access to subintima and media

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Rao AS et al: Long-term outcomes of internal carotid artery dissection. J Vasc Surg. 54(2):370-4; discussion 375, 2011
                                      2. Faivre A et al: Internal carotid artery dissection occurring during intensive practice with Wii video sports games. Neurology. 73(15):1242-3, 2009
                                      3. Georgiadis D et al: Aspirin vs anticoagulation in carotid artery dissection: a study of 298 patients. Neurology. 72(21):1810-5, 2009
                                      4. Ansari SA et al: Endovascular treatment of distal cervical and intracranial dissections with the neuroform stent. Neurosurgery. 62(3):636-46; discussion 636-46, 2008
                                      5. Chandra A et al: Spontaneous dissection of the carotid and vertebral arteries: the 10-year UCSD experience. Ann Vasc Surg. 21(2):178-85, 2007
                                      6. McIntosh A et al: Carotid artery dissection and middle cerebral artery stroke following methamphetamine use. Neurology. 67(12):2259-60, 2006
                                      7. Wu HC et al: Spontaneous bilateral internal carotid artery dissection with acute stroke in young patients. Eur Neurol. 56(4):230-4, 2006
                                      8. Biondi A et al: Progressive symptomatic carotid dissection treated with multiple stents. Stroke. 36(9):e80-2, 2005
                                      9. Edgell RC et al: Endovascular management of spontaneous carotid artery dissection. J Vasc Surg. 42(5):854-60; discussion 860, 2005
                                      10. Khan AM et al: Chiropractic sympathectomy: carotid artery dissection with oculosympathetic palsy after chiropractic manipulation of the neck. Mt Sinai J Med. 72(3):207-10, 2005
                                      11. Knibb J et al: Internal carotid artery dissection presenting with ipsilateral tenth and twelfth nerve palsies and apparent mass lesion on MRI. Br J Radiol. 78(931):659-61, 2005
                                      12. Roz TM et al: Spontaneous dissection of the internal carotid artery manifesting as pain in an endodontically treated molar. J Am Dent Assoc. 136(11):1556-9, 2005
                                      13. Badawi RA et al: Hiccups and bilateral carotid artery dissection. J R Soc Med. 97(7):331-2, 2004
                                      14. Benninger DH et al: Mechanism of ischemic infarct in spontaneous carotid dissection. Stroke. 35(2):482-5, 2004
                                      15. Kono Y et al: Carotid arteries: contrast-enhanced US angiography--preliminary clinical experience. Radiology. 230(2):561-8, 2004
                                      16. Payton TF et al: Traumatic dissection of the internal carotid artery. Pediatr Emerg Care. 20(1):27-9, 2004
                                      17. Chen YC et al: Spontaneous common carotid artery dissection: a case report and review of the literature. Eur Neurol. 50(1):58-60, 2003
                                      18. Dziewas R et al: Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 250(10):1179-84, 2003
                                      19. Irie K et al: Treatment of a spontaneous intracranial dissecting aneurysm with stent-assisted coil embolization. Neuroradiology. 45(11):825-9, 2003
                                      20. Nadgir RN et al: Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. Neuroradiology. 45(5):311-4, 2003
                                      21. Wessels T et al: Vocal cord palsy resulting from spontaneous carotid dissection. Laryngoscope. 113(3):537-40, 2003
                                      22. Logason K et al: Duplex scan findings in patients with spontaneous cervical artery dissections. Eur J Vasc Endovasc Surg. 23(4):295-8, 2002
                                      23. Zuccoli G et al: Carotid and vertebral artery dissection: magnetic resonance findings in 15 cases. Radiol Med. 104(5-6):466-71, 2002
                                      24. Brandt T et al: Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology. 57(1):24-30, 2001
                                      25. Duncan MA et al: Traumatic bilateral internal carotid artery dissection following airbag deployment in a patient with fibromuscular dysplasia. Br J Anaesth. 85(3):476-8, 2000
                                      26. Malek AM et al: Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty. AJNR Am J Neuroradiol. 21(7):1280-92, 2000
                                      27. Muller BT et al: Surgical treatment of 50 carotid dissections: indications and results. J Vasc Surg. 31(5):980-8, 2000
                                      28. Saito R et al: Combined neuroendovascular stenting and coil embolization for cervical carotid artery dissection causing symptomatic mass effect. Surg Neurol. 53(4):318-22, 2000
                                      29. Biffl WL et al: Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 47(5):845-53, 1999
                                      30. Bousson V et al: Dissections of the internal carotid artery: three-dimensional time-of-flight MR angiography and MR imaging features. AJR Am J Roentgenol. 173(1):139-43, 1999
                                      31. Nusbaum AO et al: Isolated vagal nerve palsy associated with a dissection of the extracranial internal carotid artery. AJNR Am J Neuroradiol. 19(10):1845-7, 1998
                                      32. Pica RA Jr et al: Traumatic internal carotid artery dissection presenting as delayed hemilingual paresis. AJNR Am J Neuroradiol. 17(1):86-8, 1996
                                      33. Provenzale JM: Dissection of the internal carotid and vertebral arteries: imaging features. AJR Am J Roentgenol. 165(5):1099-104, 1995
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Carotid artery dissection (CAD), internal carotid artery dissection (ICAD)
                                              • Definitions

                                                • ICAD: Delamination of ICA wall by tear or rupture of intima allowing blood to gain access to subintima and media

                                              IMAGING

                                              • General Features

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Angiographic Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Rao AS et al: Long-term outcomes of internal carotid artery dissection. J Vasc Surg. 54(2):370-4; discussion 375, 2011
                                                                          2. Faivre A et al: Internal carotid artery dissection occurring during intensive practice with Wii video sports games. Neurology. 73(15):1242-3, 2009
                                                                          3. Georgiadis D et al: Aspirin vs anticoagulation in carotid artery dissection: a study of 298 patients. Neurology. 72(21):1810-5, 2009
                                                                          4. Ansari SA et al: Endovascular treatment of distal cervical and intracranial dissections with the neuroform stent. Neurosurgery. 62(3):636-46; discussion 636-46, 2008
                                                                          5. Chandra A et al: Spontaneous dissection of the carotid and vertebral arteries: the 10-year UCSD experience. Ann Vasc Surg. 21(2):178-85, 2007
                                                                          6. McIntosh A et al: Carotid artery dissection and middle cerebral artery stroke following methamphetamine use. Neurology. 67(12):2259-60, 2006
                                                                          7. Wu HC et al: Spontaneous bilateral internal carotid artery dissection with acute stroke in young patients. Eur Neurol. 56(4):230-4, 2006
                                                                          8. Biondi A et al: Progressive symptomatic carotid dissection treated with multiple stents. Stroke. 36(9):e80-2, 2005
                                                                          9. Edgell RC et al: Endovascular management of spontaneous carotid artery dissection. J Vasc Surg. 42(5):854-60; discussion 860, 2005
                                                                          10. Khan AM et al: Chiropractic sympathectomy: carotid artery dissection with oculosympathetic palsy after chiropractic manipulation of the neck. Mt Sinai J Med. 72(3):207-10, 2005
                                                                          11. Knibb J et al: Internal carotid artery dissection presenting with ipsilateral tenth and twelfth nerve palsies and apparent mass lesion on MRI. Br J Radiol. 78(931):659-61, 2005
                                                                          12. Roz TM et al: Spontaneous dissection of the internal carotid artery manifesting as pain in an endodontically treated molar. J Am Dent Assoc. 136(11):1556-9, 2005
                                                                          13. Badawi RA et al: Hiccups and bilateral carotid artery dissection. J R Soc Med. 97(7):331-2, 2004
                                                                          14. Benninger DH et al: Mechanism of ischemic infarct in spontaneous carotid dissection. Stroke. 35(2):482-5, 2004
                                                                          15. Kono Y et al: Carotid arteries: contrast-enhanced US angiography--preliminary clinical experience. Radiology. 230(2):561-8, 2004
                                                                          16. Payton TF et al: Traumatic dissection of the internal carotid artery. Pediatr Emerg Care. 20(1):27-9, 2004
                                                                          17. Chen YC et al: Spontaneous common carotid artery dissection: a case report and review of the literature. Eur Neurol. 50(1):58-60, 2003
                                                                          18. Dziewas R et al: Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 250(10):1179-84, 2003
                                                                          19. Irie K et al: Treatment of a spontaneous intracranial dissecting aneurysm with stent-assisted coil embolization. Neuroradiology. 45(11):825-9, 2003
                                                                          20. Nadgir RN et al: Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. Neuroradiology. 45(5):311-4, 2003
                                                                          21. Wessels T et al: Vocal cord palsy resulting from spontaneous carotid dissection. Laryngoscope. 113(3):537-40, 2003
                                                                          22. Logason K et al: Duplex scan findings in patients with spontaneous cervical artery dissections. Eur J Vasc Endovasc Surg. 23(4):295-8, 2002
                                                                          23. Zuccoli G et al: Carotid and vertebral artery dissection: magnetic resonance findings in 15 cases. Radiol Med. 104(5-6):466-71, 2002
                                                                          24. Brandt T et al: Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology. 57(1):24-30, 2001
                                                                          25. Duncan MA et al: Traumatic bilateral internal carotid artery dissection following airbag deployment in a patient with fibromuscular dysplasia. Br J Anaesth. 85(3):476-8, 2000
                                                                          26. Malek AM et al: Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty. AJNR Am J Neuroradiol. 21(7):1280-92, 2000
                                                                          27. Muller BT et al: Surgical treatment of 50 carotid dissections: indications and results. J Vasc Surg. 31(5):980-8, 2000
                                                                          28. Saito R et al: Combined neuroendovascular stenting and coil embolization for cervical carotid artery dissection causing symptomatic mass effect. Surg Neurol. 53(4):318-22, 2000
                                                                          29. Biffl WL et al: Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 47(5):845-53, 1999
                                                                          30. Bousson V et al: Dissections of the internal carotid artery: three-dimensional time-of-flight MR angiography and MR imaging features. AJR Am J Roentgenol. 173(1):139-43, 1999
                                                                          31. Nusbaum AO et al: Isolated vagal nerve palsy associated with a dissection of the extracranial internal carotid artery. AJNR Am J Neuroradiol. 19(10):1845-7, 1998
                                                                          32. Pica RA Jr et al: Traumatic internal carotid artery dissection presenting as delayed hemilingual paresis. AJNR Am J Neuroradiol. 17(1):86-8, 1996
                                                                          33. Provenzale JM: Dissection of the internal carotid and vertebral arteries: imaging features. AJR Am J Roentgenol. 165(5):1099-104, 1995