Arterial Dissection

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[Taken from Bupa UK]

What is arterial dissection?

Arterial dissection occurs when the inner lining of an artery is torn, abnormally and sometimes abruptly. As this tear becomes bigger and bigger, blood leaks between the layers of your artery walls, forming a pouch, also known as a “false lumen”. Blood can accumulate here and form blood clots. When these blood clots block blood flow, or even break off and travel further up the artery and block blood flow to the brain, they can cause a stroke. 

There are two kinds of arteries that supply blood to the brain: the carotid arteries and the vertebral arteries. Your carotid arteries are on either side of your lower neck, and your vertebral arteries are in the back of your neck. Arterial dissection can happen in both kinds of arteries. Together, both kinds of arterial dissection account for 10-25% of non-hemorrhagic strokes in young and middle-aged people [1].

Sometimes, the artery can bulge in areas where the blood pools, and this is known as a pseudoaneurysm. In the neck, these can produce symptoms by causing pressure against surrounding structures. 

Arterial dissection can be spontaneous, or caused by specific traumatic injuries. Spontaneous arterial dissection accounts for about 45% of stroke cases in patients under 45 years old [2].

What are the causes of arterial dissection?

The causes of arterial dissection can be categorised into two main types: spontaneous and traumatic.

Spontaneous arterial dissection happens without trauma to the head or neck, due to certain risk factors and genetic connective tissue diseases like Marfan syndrome or vascular Ehlers-Danlos syndrome. High blood pressure and smoking increase your risk of arterial dissection. Atherosclerosis also puts people at risk for developing arterial dissection.

Traumatic arterial dissection happens due to blunt trauma injury to the head or neck, such as in a car accident, sports accident, traumatic fall, or strangulation, or any sudden movement to the neck. Artery dissection has also been seen after heavy weight lifting. It is unclear as of now if chiropractic treatment can directly cause arterial dissection.

What does having arterial dissection feel like?

In some cases, you might not even know that you have arterial dissection until a stroke occurs. Emergency treatment is needed as this is a serious medical emergency.

To remember the signs of a stroke, use the acronym, BE FAST

  • B – Balance (Is the person having trouble balancing?)
  • E – Eyes (Is the person suddenly experiencing blurred or double vision?)
  • F – Facial drooping (Is one side of a person’s face drooping, and his/her smile lopsided?)
  • A – Arm weakness (When raising both arms, does one arm fall downwards?)
  • S – Speech (Is the person’s speech slurred? Can he/she understand what you are saying?)
  • T – Time (If the person shows any of these symptoms, it is time to call an ambulance and seek medical attention immediately.) 

Over 75% of patients with stroke caused by arterial dissection can recover with minimal impact on their functioning [3].

However, in most cases, your symptoms can develop over a period of hours and days, even if arterial dissection is caused because of injuries. Symptoms usually include headache, neck and facial pain (especially around the eyes). You might also experience changes in your vision like blurry or double vision and partial blindness, tinnitus (whooshing noises in your ears) and difficulty speaking.

How is arterial dissection diagnosed?

To confirm a diagnosis of arterial dissection, your doctor might refer to your detailed medical history, family medical history, and analyse the symptoms you are experiencing.

Cerebral angiography. During a cerebral angiography, your doctor will first insert a small tube known as a catheter into a large artery. Your doctor will then use contrast dye to capture images of blood vessels and blood flow through the veins on X-ray fluoroscopy, which is a continuous X-ray image that is displayed on a monitor. 

Imaging. Other tests for diagnosis include MRI and CT scans which use smaller amounts of contrast dye and are less invasive. These scans can capture images of the head and neck, and help to visualise a tear within the artery walls. The accuracy of all these methods varies according to the location and type of dissection you have.

How is arterial dissection treated?

Arterial dissection can be treated in many different ways, depending on the size and location of the tear, but are normally treated non-surgically. The goal of treatment for arterial dissection usually is to prevent the development of further complications, like stroke, whilst the tear in your artery wall heals over.

Medications. Medications can be used to prevent blood clots, such as antiplatelet medicines or anticoagulants. If you have symptoms of a stroke and you are diagnosed quickly, doctors might use a treatment called thrombolysis, where a medicine called fibrinolytic is injected into your vein, to break up the blood clots. If a large blood clot is present, you might undergo a thrombectomy, where it’ll be pulled out with the help of a wire and stent. This can be done only a few hours after a stroke.

Surgery. Surgery for arterial dissection is only considered if you really need it. You can be treated with an angioplasty and stenting procedure, to prevent clots from forming. In an angioplasty, a balloon is inserted into your narrowed artery and inflated slowly to widen it. A stent (mesh tube) is then inserted so that it can hold its shape once the balloon is removed.

Your artery might take anywhere between 3 to 6 months to heal, whilst you are monitored for further complications or side-effects from medications used.

If you suspect that you have arterial dissection, book an appointment with your doctor to run some tests and find out more about the treatment options available for you.

Sources

  1. Campos-Herrera, C. R., Scaff, M., Yamamoto, F. I., & Conforto, A. B. (2008). Spontaneous cervical artery dissection: an update on clinical and diagnostic aspects. Arquivos de Neuro-Psiquiatria, 66(4), 922–927. https://doi.org/10.1590/s0004-282×2008000600036
  2. Kim, Y.-K., & Schulman, S. (2009). Cervical artery dissection: Pathology, epidemiology and management. Thrombosis Research, 123(6), 810–821. https://doi.org/10.1016/j.thromres.2009.01.013
  3. Carotid Artery Dissection: Background, Pathophysiology, Etiology. (2020). EMedicine. https://emedicine.medscape.com/article/757906-overview
  4. Cervical artery dissection | Health Information | Bupa UK. (2017). Bupa.co.uk. https://www.bupa.co.uk/health-information/heart-blood-circulation/cervical-artery-dissection
  5. Cervical (Carotid or Vertebral) Artery Dissection. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/16857-cervical-carotid-or-vertebral-artery-dissection
  6. McNamara, L. (2015, October 5). Arterial Dissection. Hopkinsmedicine.org. https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/pediatric_neurovascular/conditions/arterial%20dissection.html