Treatment of Carotid Dissection

Spontaneous carotid dissection is a rare cause of stroke, accounting for up to 2% of cases. However, in individuals under 50 years of age, it is responsible for 25–30% of stroke symptoms. Carotid or vertebral dissection can lead to artery thrombosis, distal thromboembolic complications, stenosis or occlusion of the carotid/vertebral artery, and aneurysm formation. The mechanisms of dissection include intimal tear, vasa vasorum rupture, and intramural hematoma, which contribute to the symptoms. Patients typically present with unilateral facial or neck pain, headache, Horner syndrome (ptosis and miosis), and nerve compression. However, dissection can also manifest as a stroke or, less commonly, as spinal ischemia. Unspecified symptoms can lead to delayed diagnosis and progression of the condition. Detailed anamnesis and neurological examination are essential for diagnosing carotid dissection. Doppler ultrasound is the preferred initial diagnostic tool due to its high accuracy for carotid dissection, though it is less effective for vertebral artery dissection. Possible ultrasound findings include intimal flap, double lumen, thrombus, stenosis/occlusion, or dissection aneurysm. Cross-sectional imaging methods, such as computed tomography (CT) and magnetic resonance angiography (MRA), are also excellent diagnostic tools.