scholarly journals Internal carotid and vertebral artery dissection: morphology, pathophysiology and provoking factors

2019 ◽  
pp. 72-78
Author(s):  
LA Kalashnikova ◽  
TS Gulevskaya ◽  
AV Sakharova ◽  
RP Chaykovskaya ◽  
MV Gubanova ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Vertebral Artery ◽  
Arterial Wall ◽  
Internal Carotid ◽  
Vertebral Artery Dissection ◽  
Clinical Signs ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
Arterial Dissection ◽  
Artery Dissection ◽  
Elastic Membrane

The causes of internal carotid artery (ICA) and vertebral artery (VA) dissection, as well as its provoking factors, remain understudied. The aim of this paper was to explore morphological changes in the ICA/VA walls, factors provoking dissection, clinical signs and biomarkers of connective tissue (CT) damage. A total of 271 patients were examined, of whom 54% were women. The mean age of the participants was 37.0 ± 10 years. Clinical signs and biomarkers of CT damage (matrix metalloproteinase 9, tissue inhibitor of metalloproteinase 1, hydroxyproline, sulphated glycosaminoglycans) were analyzed in 82 patients and 40 healthy volunteers. Histologic examination of dissected and seemingly intact arteries conducted in 5 cases revealed signs of arterial wall dysplasia similar to those characteristics of fibromuscular dysplasia: thinning and splitting of the internal elastic membrane, areas of fibrosis, irregular orientation of myocytes, and their necrosis in the tunica media. Clinical signs and biomarkers of CT dysplasia (CTD) were more pronounced in patients with arterial dissection than in the controls. The major provoking factors were head turns and physical activity (42%), minor head injury (10%), and acute respiratory infection in the month preceding arterial dissection (14%). We conclude that arterial wall dysplasia is a predisposing factor for ICA/VA dissection, both spontaneous and provoked. The analysis of CTD biomarkers and clinical signs suggests connective tissue pathology in patients with ICA/VA dissection.

Carotid and Vertebral Artery Dissection Syndromes.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4145-4145
Author(s):  
Beatriz Grand ◽  
Jorge Solimano ◽  
Adriana Ventura ◽  
Ernesto Quiroga Micheo ◽  
Dardo Riveros
Keyword(s):  
Vertebral Artery ◽  
Clinical Presentation ◽  
Oral Anticoagulants ◽  
Vertebral Artery Dissection ◽  
Clinical Signs ◽  
Young Patients ◽  
Complete Recovery ◽  
Artery Dissection ◽  
Hemorrhagic Complication ◽  
Progressing Stroke

Abstract Objetives: To describe the clinical presentation, diagnosis and treatment of patients with carotid and vertebral artery dissection (CAD, VAD). Design: Retrospective, observational Patients and methods: Clinical recording were evaluated from 1996 to 2005; 6 patients (3 women, 3 men, mean age 37 years) with CAD (3) and VAD (3) were referred to our hematology unit. Clinical presentation: progressing stroke 4/6 and transient ischemic attack (TIA) 2/6; warning sings and symptoms preceding the onset of stroke in 80%. Vascular risk factors included smoking and hypertension; associated features were headache, visual symptoms and Horner’s syndrome; Predisposing factors as physical exercise and trauma were found in 4/6. One patient was at 20 weeks of pregnancy. Diagnosis: Diagnostic tests included: Doppler ultrasound, magnetic resonance imaging (MRI) and angiography (MRA). On admission angiographic studies showed occlusion or stenoses of dissected arteries. Treatment: Anticoagulation with heparin or low molecular weight heparin followed by oral anticoagulants. Outcome: No hemorrhagic complication, no recurrence, complete recovery in 5 patients and mild dysarthria in one. Conclusion: TIA and progressing stroke in young patients are presenting features of CAD and VAD. The diagnosis is based on clinical signs and confirming angiographic investigation. Our experience shows that anticoagulation is the treatment of choice, although controlled studies to show their effectiveness are lacking.

scholarly journals Bilateral Internal Carotid and Left Vertebral Artery Dissection after Blunt Trauma: A Case Report and Literature Review

2019 ◽  
Vol 59 (4) ◽  
pp. 154-161 ◽  
Author(s):  
Kenichi ARIYADA ◽  
Keita SHIBAHASHI ◽  
Hidenori HODA ◽  
Shinta WATANABE ◽  
Masahiro NISHIDA ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Vertebral Artery ◽  
Blunt Trauma ◽  
Internal Carotid ◽  
Vertebral Artery Dissection ◽  
Left Vertebral Artery ◽  
Artery Dissection

Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography

1994 ◽  
Vol 80 (4) ◽  
pp. 667-674 ◽  
Author(s):  
Chifumi Kitanaka ◽  
Jun-Ichi Tanaki ◽  
Masanori Kuwahara ◽  
Akira Teraoka ◽  
Tomio Sasaki ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Bed Rest ◽  
Arterial Dissection ◽  
Artery Dissection ◽  
Aneurysmal Dilatation ◽  
Content Type ◽  
Brain Stem Ischemia ◽  
Fine Print

✓ The question of whether unruptured intracranial vertebral artery dissections should be treated surgically or nonsurgically still remains unresolved. In this study, six consecutive patients with intracranial vertebral artery dissection presenting with brain-stem ischemia without subarachnoid hemorrhage (SAH) were treated nonsurgically with control of blood pressure and bed rest, and five received follow-up review with serial angiography. No further progression of dissection or associated SAH occurred in any of the cases, and all patients returned to their previous lifestyles. In the serial angiograms in five patients, the findings continued to change during the first few months after onset. Four cases ultimately showed “angiographic cure,” while fusiform aneurysmal dilatation of the affected vessel persisted in one case. In one patient, arterial dissection was visualized on the second angiogram despite negative initial angiographic findings. These results indicate that intracranial vertebral artery dissection presenting without SAH can be treated nonsurgically, with careful angiographic follow-up monitoring. Persistent aneurysmal dilatation as a sequela of arterial dissection seemed to form a subgroup of fusiform aneurysms of the posterior circulation. These aneurysms may be prone to late bleeding and may require surgical treatment.

Clinical import of Horner syndrome in internal carotid and vertebral artery dissection

Neurology ◽  
2014 ◽  
Vol 82 (18) ◽  
pp. 1653-1659 ◽  
Author(s):  
P. A. Lyrer ◽  
T. Brandt ◽  
T. M. Metso ◽  
A. J. Metso ◽  
M. Kloss ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Internal Carotid ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Horner Syndrome

Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Christina Xia ◽  
Lee Pfaff ◽  
Navreet Kaur ◽  
Neil Suryadevara ◽  
Hesham Masoud
Keyword(s):  
Vertebral Artery ◽  
Motor Vehicle ◽  
Vertebral Artery Dissection ◽  
Clinical Signs ◽  
The United States ◽  
Homonymous Hemianopia ◽  
Artery Dissection ◽  
Multiple Chronic Conditions ◽  
Cervical Artery Dissection ◽  
Patient Reported

Introduction : Traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45. Recent chiropractic neck manipulation is associated with risk of vertebral artery dissection (VAD). The V3 segment of the vertebral artery is highly susceptible to the bending forces during forced manipulation leading to intimal damage. Methods : N/A Results : This is a case presentation of a 44 year old male who was transferred from another emergency department for left homonymous inferior quadrantanopia noted on an optometrist visit. He reported sudden onset left homonymous hemianopia after receiving a high velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior. CT angiogram of the head and neck revealed bilateral vertebral artery dissection at left V2 and right V3 segments. MRI brain confirmed an acute infract in the right medial occipital lobe. His right PCA stroke was likely embolic from the injured right V3 but possibly from the left V2 as well. As the patient reported progression from a homonymous hemianopia to a quadrantanopia, he likely had a migrating embolus. Conclusions : Arterial dissection accounts for about 2% of all ischemic strokes, but may be between 8–25% in patients less than 45 years old. VAD can result from trauma of varying severities ‐ from sports, motor vehicle accidents, and chiropractor neck manipulations to violent coughing/sneezing. It is estimated that 1 in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection. In the United States, patients who have multiple chronic conditions are reporting higher use of complementary or alternative medicine, including chiropractic manipulation. Education about the association of VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. In addition, vertebral artery dissection symptoms can be subtle and patients presenting to chiropractors may have distracting pain masking their deficits. Evaluating for appropriateness of cervical manipulation in high‐risk patients and detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients.

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