Carotid Artery Dissection: Tear in the Carotid Arteries

Introduction

The carotid arteries are extremely vast and robust blood vessels of the cardiovascular system that constantly supply pure blood or oxygenated blood to the brain, where critical thinking, speech, and sensory and motor functions are performed. It is possible to feel the pulse in the carotid arteries over the sides of the neck or just below the jaw. Carotid artery dissection refers to the splitting or tearing of the inner layers of the carotid artery. Carotid artery dissection is the leading cause of stroke in young individuals. Dissection can be understood as the blistering of the inner layers of a blood vessel which is the aftermath of a leakage within the blood vessel. Trauma to the head or neck due to accidents and strangulations may occur before a carotid artery dissection.

What Are the Causes of Carotid Artery Dissection?

There are two broad categories to understand the causative factor behind a carotid artery dissection- spontaneous and traumatic.

• Spontaneous carotid artery dissection was thought to be sporadic but with the recent reports of carotid artery dissection, it has been proved that a spontaneous cause is one of the leading etiological factors behind stroke in younger individuals caused because of carotid artery dissection. Middle-aged individuals have the potential to develop the condition due to spontaneous carotid artery dissection as well.

• Traumatic carotid artery dissection has been fairly common for ages and is due to violent trauma to the head or the neck such as motor vehicle accidents, blunt injury, etc. the quick deceleration during a traumatic injury leads to hyperextension along with neck rotation that stretches the carotid artery to deeper levels resulting in a tear. The patient remains asymptomatic for a few hours and then suddenly develops a stroke.

There are several other etiological factors that cannot be categorized under spontaneous or traumatic events. Mentioned below are a few of the various causes of carotid artery dissection.

• Marfan syndrome.

• Ehlers-Danlos syndrome.

• Autosomal dominant polycystic kidney disease.

• Pseudoxanthoma elasticum.

• Fibromuscular dysplasia.

• Osteogenesis imperfecta I.

• IgG4 disorders.

• Connective tissue diseases.

• Eagle syndrome.

• Sports activities like Jiu-Jitsu.

• Intimal dissections.

• Pseudoaneurysms.

• Thromboses.

• Fistulas.

• Neck manipulation.

• Chiropractic practices.

What Changes Occur in the Body During a Carotid Artery Dissection?

Carotid artery dissection occurs when there is a tear, small or large, in the innermost layer of the artery, that expands and eventually causes a tear through and through the vessel. Tunica intima is the innermost layer that gets the initial split or tear. Blood flows through this tear into the outer layers leading to stenosis and eventually total occlusion of the blood vessel. Ischemia is the aftermath of a total occlusion of the torn blood vessel. The next change is the formation of a blood clot, followed by the development of an emboli that travels to different parts of the brain as well as the body. This emboli gets stuck in the tiny blood vessels of the brain and leads to a stroke. A stroke results in damage to the brain that cannot be reversed or corrected.

What Are the Signs and Symptoms of Carotid Artery Dissection?

Carotid artery dissection is the tear in the carotid artery. The patient may remain asymptomatic for a fairly long span of time because once the carotid artery is torn, the brain may continue to function because of the smooth flow of blood through the other blood vessels. This may not last long though.

Mentioned below are a few of the signs and symptoms of carotid artery dissection.

• Sweating.

• Lightheadedness.

• Vomiting.

• Stroke.

• High blood pressure.

• Interscapular ache.

• Fainting.

• Paralysis.

• Sudden weakness of the face.

• Liability of the arm or leg.

• Severe dizziness.

• Balance problems.

• Difficulty walking.

• Confusion.

• Hypotension.

• Headache in one side of the brain.

• Pain around the eyes.

• Neck discomfort and pain.

• Swelling of the tongue.

• Problems with depth perception.

• Not understanding directions.

• Memory problems.

• Difficulty in problem-solving.

• Not able to make decisions.

• Problems in breathing.

• Difficulty in chewing and swallowing.

• Horner syndrome.

• Pulsatile tinnitus.

• Temporary loss of vision.

• Ischemia.

How to Diagnose Carotid Artery Dissection?

Medical history as well as history of any trauma, accident, or chiropractic session must be taken in detail. Physical examination is very important followed by several imaging tests that serve as a fully-fledged diagnostic measure to determine the positive presence of carotid artery dissection.

Mentioned below are a few of the carotid artery dissection diagnostic tools.

• Duplex ultrasound.

• Computed tomography angiography.

• Cerebral angiography.

• Magnetic resonance angiography.

• Chest X-ray.

• Infrared thermography.

• Digital subtraction angiography.

• Magnetic resonance imaging or MRI.

How to Treat Carotid Artery Dissection?

The treatment of carotid artery stenosis needs to be done promptly in order to avoid permanent damage to the brain or related structures. The aim of the treatment is to avoid any formation of neurological deficits. A surgical intervention proves one of the most successful treatment plans for carotid artery dissection. This surgical procedure is generally performed by an interdisciplinary team that comprises mainly vascular surgeons. It should be noted that going into the surgical path is suggested only after strong medication therapy has failed.

Mentioned below are a few of the treatment and management modalities of carotid artery dissection.

• Anti-platelet therapy.

• Anticoagulation agents.

• Stent implantation.

• Carotid endarterectomy.

• Carotid artery ligation.

• Alteplase or Activase injection.

• Tenecteplase injection.

• Surgical intervention.

Conclusion

Carotid artery dissection refers to the tear or split in the carotid artery. This tear occurs within the innermost layer of the blood vessel and expands to the outermost layer. The tear keeps splitting and getting wider eventually resulting in a clot formation, followed by ischemia and finally stroke. Young patients as well as young adults have the potential to develop carotid artery stenosis due to the nature of its etiological factors which include car accidents, rough physical activity, sports, and chiropractic sessions. The patient may remain asymptomatic at the beginning but early diagnosis and prompt treatment are vital for a positive outlook after treatment.