Cardiovascular

Carotid artery dissection

Blood enters the wall of a cervical carotid artery and forms an intramural haematoma whose raw surface embolises to the retina or brain, hours to days after the pain starts.

Definition

Separation of the layers of a cervical carotid artery wall by blood entering through an intimal tear or an intramural bleed, producing a mural haematoma. On angiography it appears as a segmental or long tapering stenosis, an occlusion or a dissecting aneurysm. Carotid dissection is one form of cervical artery dissection; the other is vertebral.

First principles

The haematoma is in the wall, not the lumen

A small proportion of ischaemic strokes are caused by dissection of a carotid or vertebral artery. Blood tracks between the layers of the arterial wall through an intimal tear or an intramural bleed. On angiography this gives a long tapering stenosis, an occlusion or a dissecting aneurysm, often more than one at once. More than one cervical artery is involved in 15% to 20% of patients.

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