Carotid artery dissection

Carotid dissection may be spontaneous, traumatic or iatrogenic. The incidence of this disease is very low. Carotid dissection is a rare cause of ischemic stroke and the instrumental diagnosis includes conventional angiography, magnetic resonance imaging, ultrasound techniques and helical computed tomography angiography. Anticoagulant therapies are recommended for all the patients regardless by dissection's aetiology in order to prevent thromboembolic complications. Options for open surgical repair include resection of the involved segment with interposition of vein graft, thromboendarterectomy and patch closure, extracranial to intracranial carotid artery bypass, gradual dilation of the carotid artery and ligation of the cervical carotid artery. More recently endovascular techniques have been used to treat high-grade stenosis and aneurysmal dilatation as a consequence of a carotid dissection. No evidence exists about the benefits of one technique than the others. In any case, surgical or endovascular treatment should be reserved for patients who have persistent symptoms of ischemia despite adequate anticoagulation. In this report we review recent new knowledges in epidemiology and pathogenesis of carotid artery dissection, paying particular attention to clinical manifestations, methods of diagnosis and kinds of treatment.