Cervical Artery Dissections: Etiopathogenesis and Management
Zafer Keser,1 Chia-Chun Chiang,1 John C Benson,2 Alessandro Pezzini,3 Giuseppe Lanzino4 1Department of Neurology, Mayo Clinic, Rochester, MN, USA; 2Department of Radiology, Mayo Clinic, Rochester, MN, USA; 3Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Br...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2022-09-01
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| Series: | Vascular Health and Risk Management |
| Subjects: | |
| Online Access: | https://www.dovepress.com/cervical-artery-dissections-etiopathogenesis-and-management-peer-reviewed-fulltext-article-VHRM |
| _version_ | 1828109139301105664 |
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| author | Keser Z Chiang CC Benson JC Pezzini A Lanzino G |
| author_facet | Keser Z Chiang CC Benson JC Pezzini A Lanzino G |
| author_sort | Keser Z |
| collection | DOAJ |
| description | Zafer Keser,1 Chia-Chun Chiang,1 John C Benson,2 Alessandro Pezzini,3 Giuseppe Lanzino4 1Department of Neurology, Mayo Clinic, Rochester, MN, USA; 2Department of Radiology, Mayo Clinic, Rochester, MN, USA; 3Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy; 4Department of Neurosurgery, Mayo Clinic, Rochester, MN, USACorrespondence: Zafer Keser, Department of Neurology – Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA, Email keser.zafer@mayo.eduAbstract: Cervical Artery Dissection (CeAD) is a frequent stroke etiology for patients younger than 50 years old. The most common immediate complications related to CeAD are headache and neck pain (65– 95%), TIA/ischemic stroke (> 50%), and partial Horner’s syndrome (25%). The prevailing hypothesis regarding the pathogenesis of sCeAD is that the underlying constitutional vessel wall weakness of patients with sCeAD is genetically determined and that environmental factors could act as triggers. The stroke prevention treatment of CeAD remains controversial, involving anticoagulation or antiplatelet therapy and potentially emergent stenting and/or thrombectomy or angioplasty for selected cases of carotid artery dissection with occlusion. The treatment of headache associated with CeAD depends on the headache phenotype and comorbidities. Radiographically, more than 75% of CeAD cases present with occlusion or non-occlusive stenosis. Many patients demonstrate partial and complete healing, more commonly in the carotid arteries. One-fifth of the patients develop dissecting pseudoaneurysm, but this is a benign clinical entity with an extremely low rupture and stroke recurrence risk. Good recovery is achieved in many CeAD cases, and mortality remains low. Family history of CeAD, connective tissue disorders like Ehlers-Danlos syndrome type IV, and fibromuscular dysplasia are risk factors for recurrent CeAD, which can occur in 3– 9% of the cases. This review serves as a comprehensive, updated overview of CeAD, emphasizing etiopathogenesis and management.Keywords: cervical artery dissection, genetics, stroke |
| first_indexed | 2024-04-11T10:57:49Z |
| format | Article |
| id | doaj.art-b52d4f991bb74d3eaeb45e7706de85ef |
| institution | Directory Open Access Journal |
| issn | 1178-2048 |
| language | English |
| last_indexed | 2024-04-11T10:57:49Z |
| publishDate | 2022-09-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-b52d4f991bb74d3eaeb45e7706de85ef2022-12-22T04:28:43ZengDove Medical PressVascular Health and Risk Management1178-20482022-09-01Volume 1868570077912Cervical Artery Dissections: Etiopathogenesis and ManagementKeser ZChiang CCBenson JCPezzini ALanzino GZafer Keser,1 Chia-Chun Chiang,1 John C Benson,2 Alessandro Pezzini,3 Giuseppe Lanzino4 1Department of Neurology, Mayo Clinic, Rochester, MN, USA; 2Department of Radiology, Mayo Clinic, Rochester, MN, USA; 3Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy; 4Department of Neurosurgery, Mayo Clinic, Rochester, MN, USACorrespondence: Zafer Keser, Department of Neurology – Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA, Email keser.zafer@mayo.eduAbstract: Cervical Artery Dissection (CeAD) is a frequent stroke etiology for patients younger than 50 years old. The most common immediate complications related to CeAD are headache and neck pain (65– 95%), TIA/ischemic stroke (> 50%), and partial Horner’s syndrome (25%). The prevailing hypothesis regarding the pathogenesis of sCeAD is that the underlying constitutional vessel wall weakness of patients with sCeAD is genetically determined and that environmental factors could act as triggers. The stroke prevention treatment of CeAD remains controversial, involving anticoagulation or antiplatelet therapy and potentially emergent stenting and/or thrombectomy or angioplasty for selected cases of carotid artery dissection with occlusion. The treatment of headache associated with CeAD depends on the headache phenotype and comorbidities. Radiographically, more than 75% of CeAD cases present with occlusion or non-occlusive stenosis. Many patients demonstrate partial and complete healing, more commonly in the carotid arteries. One-fifth of the patients develop dissecting pseudoaneurysm, but this is a benign clinical entity with an extremely low rupture and stroke recurrence risk. Good recovery is achieved in many CeAD cases, and mortality remains low. Family history of CeAD, connective tissue disorders like Ehlers-Danlos syndrome type IV, and fibromuscular dysplasia are risk factors for recurrent CeAD, which can occur in 3– 9% of the cases. This review serves as a comprehensive, updated overview of CeAD, emphasizing etiopathogenesis and management.Keywords: cervical artery dissection, genetics, strokehttps://www.dovepress.com/cervical-artery-dissections-etiopathogenesis-and-management-peer-reviewed-fulltext-article-VHRMcervical artery dissectiongeneticsstroke |
| spellingShingle | Keser Z Chiang CC Benson JC Pezzini A Lanzino G Cervical Artery Dissections: Etiopathogenesis and Management Vascular Health and Risk Management cervical artery dissection genetics stroke |
| title | Cervical Artery Dissections: Etiopathogenesis and Management |
| title_full | Cervical Artery Dissections: Etiopathogenesis and Management |
| title_fullStr | Cervical Artery Dissections: Etiopathogenesis and Management |
| title_full_unstemmed | Cervical Artery Dissections: Etiopathogenesis and Management |
| title_short | Cervical Artery Dissections: Etiopathogenesis and Management |
| title_sort | cervical artery dissections etiopathogenesis and management |
| topic | cervical artery dissection genetics stroke |
| url | https://www.dovepress.com/cervical-artery-dissections-etiopathogenesis-and-management-peer-reviewed-fulltext-article-VHRM |
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