Cor Vasa 2025, 67(5):631-640 | DOI: 10.33678/cor.2025.075
(Isolated dissection of the internal carotid artery)
- Klinika angiológie, LF UPJŠ a Východoslovenský ústav srdcových a cievnych chorôb, a.s., Košice, Slovenská republika
Isolated dissection of the internal carotid artery is a serious medical condition due to the risk of ischemic stroke developing, especially in young patients. Its management is complex, consisting of pharmacological and non-pharmacological, endovascular treatment. Each of the treatment options must be strictly indicated after meeting the strict indications. The aim of this article is to provide the reader with a comprehensive view of this disease from etiopathogenesis to treatment and prognosis. The most important goal is to provide the most up-to-date knowledge about the method of treatment and the indications of each treatment option.
Keywords: Carotid stenting, Isolated carotid dissection, Mechanical thrombectomy, Stroke,
Received: October 7, 2024; Revised: June 29, 2025; Accepted: July 2, 2025; Prepublished online: June 2, 2012; Published: November 6, 2025 Show citation
References
- Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 2009;8:668-678.
Go to original source...
Go to PubMed... - Lee VH, Brown RD, Mandrekar JN, et al. Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006;67:1809-1812.
Go to original source...
Go to PubMed... - Béjot Y, Daubail B, Debette S, et al. Incidence and outcome of cerebrovascular events related to cervical artery dissection: the Dijon Stroke Registry. Int J Stroke 2014;9:879-882.
Go to original source...
Go to PubMed... - Lee VH, Brown RD Jr, Mandrekar JN, et al. Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006;67:1809-1812.
Go to original source...
Go to PubMed... - Arnold M, Bousser MG, Fahrni G, et al. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 2006;37:2499-2503.
Go to original source...
Go to PubMed... - Arauz A, Ruiz A, Pacheco G, et al. Aspirin versus anticoagulation in intra- and extracranial vertebral artery dissection. Eur J Neurol 2013;20:167-172.
Go to original source...
Go to PubMed... - Kwak JH, Choi JW, Park HJ, et al. Cerebral artery dissection: spectrum of clinical presentations related to angiographic findings. Neurointervention 2011;6:78-83.
Go to original source...
Go to PubMed... - Huang YC, Chen YF, Wang YH, et al. Cervicocranial arterial dissection: experience of 73 patients in a single center. Surg Neurol 2009;72(Suppl 2):S20-S27. discussion S27.
Go to original source...
Go to PubMed... - Eagle WW. Elongated styloid process: further observations and a new syndrome. Arch Otolaryngol 1948;47:630-640.
Go to original source...
Go to PubMed... - Pagano S, Ricciuti V, Mancini F, et al. Eagle syndrome: An updated review. Surg Neurol Int 2023;14:389.
Go to original source...
Go to PubMed... - Eagle WW. Symptomatic elongated styloid process report of two cases of styloid process-carotid artery syndrome with operation. Arch Otolaryngol 1949;49:490-503.
Go to original source...
Go to PubMed... - Abdelnour LH, Kurdy M, Idris A. Association of styloid process length with cervical carotid artery dissection: Meta-analysis. Health Sciences Review 2023;9:100134.
Go to original source... - Nadgir RN, Loevner LA, Ahmed T, et al. Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. Neuroradiology 2003;45:311-314.
Go to original source...
Go to PubMed... - Chung CLR, Côté P, Stern P, et al. The Association Between Cervical Spine Manipulation and Carotid Artery Dissection: A Systematic Review of the Literature. J Manipulative Physiol Ther 2015;38:672-676.
Go to original source...
Go to PubMed... - Keser Z, Chiang CC, Benson JC, et al. Cervical Artery Dissections: Etiopathogenesis and Management. Vasc Health Risk Manag 2022;18:685-700.
Go to original source...
Go to PubMed... - Biller J, Sacco RL, Albuquerque FC, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American heart association/American stroke association. Stroke 2014;45:3155-3174.
Go to original source...
Go to PubMed... - Fusco MR, Harrigan MR. Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery 2011;68:517-530.
Go to original source...
Go to PubMed... - Stamboulis E, Raptis G, Andrikopoulou A, et al. Spontaneous internal carotid artery dissection: an uncommon cause of recurrent postpartum headache. J Neuroimaging 2011;21:76-78.
Go to original source...
Go to PubMed... - Caso V, Paciaroni M, Bogousslavsky J. Environmental factors and cervical artery dissection. Front Neurol Neurosci 2005;20:44-53.
Go to original source...
Go to PubMed... - Grau AJ, Brandt T, Buggle F, et al. Association of cervical artery dissection with recent infection. Arch Neurol 1999;56:851-856.
Go to original source...
Go to PubMed... - Grond-Ginsbach G, Debette S, Pezzini A. Genetic approaches in the study of risk factors for cervical artery dissection. Handbook Cerebral Artery Dissection 2005;20:30-43.
Go to original source...
Go to PubMed... - Debette S. Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts? Curr Opin Neurol 2014;27:20-28.
Go to original source...
Go to PubMed... - Adham S, Billon C, Legrand A, et al. Spontaneous Cervical Artery Dissection in Vascular Ehlers-Danlos Syndrome: a Cohort Study. Stroke 2021;52:1628-1635.
Go to original source...
Go to PubMed... - Grond-Ginsbach C, Brandt T, Kloss M, et al. Next generation sequencing analysis of patients with familial cervical artery dissection. Eur Stroke J 2017;2:137-143.
Go to original source...
Go to PubMed... - Traenka C, Kloss M, Strom T, et al. Rare genetic variants in patients with cervical artery dissection. Eur Stroke J 2019;4:355-362.
Go to original source...
Go to PubMed... - Debette S, Goeggel Simonetti B, Schilling S, et al. CADISP-plus consortium. Familial occurrence and heritable connective tissue disorders in cervical artery dissection. Neurology 2014;83:2023-2031.
Go to original source...
Go to PubMed... - Debette S, Kamatani Y, Metso TM, et al. Common variation in PHACTR1 is associated with susceptibility to cervical artery dissection. Nat Genet 2015;47:78-83.
Go to original source...
Go to PubMed... - Kiando SR, Tucker NR, Castro-Vega LJ, et al. PHACTR1 is a genetic susceptibility locus for fibromuscular dysplasia supporting its complex genetic pattern of inheritance. PLoS Genet 2016;12:e1006367.
Go to original source...
Go to PubMed... - Anttila V, Winsvold BS, Gormley P, et al. Genome-wide meta-analysis identifies new susceptibility loci for migraine. Nat Genet 2013;45:912-917.
Go to original source...
Go to PubMed... - Giossi A, Ritelli M, Costa P, et al. Connective tissue anomalies in patients with spontaneous cervical artery dissection. Neurology 2014;83:2032-2037.
Go to original source...
Go to PubMed... - Kim BJ, Yang E, Kim NY, et al. Vascular Tortuosity May Be Associated With Cervical Artery Dissection. Stroke 2016;47:2548-2552.
Go to original source...
Go to PubMed... - Olin JW, Froehlich J, Gu X, et al. The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients. Circulation 2012;125:3182-3190.
Go to original source...
Go to PubMed... - Talarowska P, Dobrowolski P, Klisiewicz A, et al. High incidence and clinical characteristics of fibromuscular dysplasia in patients with spontaneous cervical artery dissection: the ARCADIA-POL study. Vasc Med 2019;24:112-119.
Go to original source...
Go to PubMed... - Guillon B, Berthet K, Benslamia L, et al. Infection and the risk of spontaneous cervical artery dissection: a case-control study. Stroke 2003;34:e79-e81.
Go to original source...
Go to PubMed... - Debette S, Metso T, Pezzini A, et al. Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation 2011;123:1537-1544.
Go to original source...
Go to PubMed... - Pezzini A, Caso V, Zanferrari C, et al. Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case- -control study. J Neurol Neurosurg Psychiatry 2006;77:95-97.
Go to original source...
Go to PubMed... - Benninger DH, Herrmann FR, Georgiadis D, et al. Increased prevalence of hyperhomocysteinemia in cervical artery dissection causing stroke: a case-control study. Cerebrovasc Dis 2009;27:241-246.
Go to original source...
Go to PubMed... - Engelter ST, Grond-Ginsbach C, Metso TM, et al. Cervical artery dissection: trauma and other potential mechanical trigger events. Neurology 2013;80:1950-1957.
Go to original source...
Go to PubMed... - Debette S, Mazighi M, Bijlenga P, et al. ESO guideline for the management of extracranial and intracranial artery dissection. Eur Stroke J 2021;6:XXXIX-LXXXVIII.
Go to original source...
Go to PubMed... - Gallerini S, Marsili L, Bartalucci M, et al. Headache secondary to cervical artery dissections: practice pointers. Neurol Sci 2019;40:613-615.
Go to original source...
Go to PubMed... - Lai SL, Chang YY, Liu JS, et al. Cluster-like headache from vertebral artery dissection: angiographic evidence of neurovascular activation. Cephalalgia 2005;25:629-632.
Go to original source...
Go to PubMed... - Shankar Kikkeri N, Nagarajan E, Sakuru RC, et al. Horner Syndrome Due to Spontaneous Internal Carotid Artery Dissection. Cureus 2018;10:e3382.
Go to original source...
Go to PubMed... - Kellert L, Kloss M, Pezzini A, et al. Prognostic significance of pulsatile tinnitus in cervical artery dissection. Eur J Neurol 2016;23:1183-1187.
Go to original source...
Go to PubMed... - Mokri B, Silbert PL, Schievink WI, et al. Cranial nerve palsy in spontaneous dissection of the extracranial internal carotid artery. Neurology 1996;46:356-359.
Go to original source...
Go to PubMed... - English SW, Passe TJ, Lindell EP, et al. Multiple cranial neuropathies as a presentation of spontaneous internal carotid artery dissection: a case report and literature review. J Clin Neurosci 2018;50:129-131.
Go to original source...
Go to PubMed... - Mizutani T. Natural course of intracranial arterial dissections. J Neurosurg 2011;114:1037-1044.
Go to original source...
Go to PubMed... - Marnat G, Lapergue B, Sibon I, et al. TITAN and ETIS Investigators. Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions: A Pooled Analysis of TITAN and ETIS. Stroke 2020;51: 3713-3718.
Go to original source...
Go to PubMed... - Da Ros V, Pusceddu F, Lattanzi S, et al. Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: a multicenter experience. Neuroradiol J 2023;36:86-93.
Go to original source...
Go to PubMed... - Da Ros V, Scaggiante J, Pitocchi F, et al. Mechanical thrombectomy in acute ischemic stroke with tandem occlusions: impact of extracranial carotid lesion etiology on endovascular management and outcome. Neurosurg Focus 2021;51:E6.
Go to original source...
Go to PubMed... - Markus HS, Hayter E, Levi C, et al. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol 2015;14:361-367.
Go to original source...
Go to PubMed... - Markus HS, Levi C, King A, et al. Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the cervical artery dissection in stroke study (CADISS) randomized clinical trial final results. JAMA Neurol 2019;76:657-664.
Go to original source...
Go to PubMed... - Engelter ST, Traenka C, Gensicke H, et al. Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial. Lancet Neurol 2021;20:341-350.
Go to original source...
Go to PubMed... - Yaghi S, Shu L, Mandel D, et al. Antithrombotic treatment for stroke prevention in cervical artery dissection: the STOP-CAD study. Stroke 2024;55:908-918.
Go to original source...
Go to PubMed... - Bernstein RA, Previch L, Caprio FZ. Data Over Dogma in Treatment of Cervical Artery Dissections. Stroke 2024;55:919-920.
Go to original source...
Go to PubMed... - Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021;52:e364-e467.
Go to original source...
Go to PubMed... - Compter A, Schilling S, Vaineau CJ, et al. CADISP-plus Consortium. Determinants and outcome of multiple and early recurrent cervical artery dissections. Neurology 2018;91: e769-e780.
Go to original source...
Go to PubMed... - Larsson SC, King A, Madigan J, et al. Prognosis of carotid dissecting aneurysms: results from CADISS and a systematic review. Neurology 2017;88:646-652.
Go to original source...
Go to PubMed... - Bontinis V, Antonopoulos CN, Bontinis A, et al. A Systematic Review and Meta-Analysis of Carotid Artery Stenting for the Treatment of Cervical Carotid Artery Dissection. Eur J Vasc Endovasc Surg 2022;64:299-308.
Go to original source...
Go to PubMed... - Yaghi S, Engelter S, Del Brutto VJ, et al. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Peripheral Vascular Disease. Treatment and Outcomes of Cervical Artery Dissection in Adults: A Scientific Statement From the American Heart Association. Stroke 2024;55: e91-e106.
Go to original source...
Go to PubMed... - Vellimana AK, Lavie J, Chatterjee AR. Endovascular Considerations in Traumatic Injury of the Carotid and Vertebral Arteries. Semin Intervent Radiol 2021;38:53-63.
Go to original source...
Go to PubMed... - Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2020;88:875-887.
Go to original source...
Go to PubMed... - Lauzier DC, Chatterjee AR, Kansagra AP. Neurointerventional management of cerebrovascular trauma. J Neurointerv Surg 2022;14:718-722.
Go to original source...
Go to PubMed... - Harrigan MR. Ischemic Stroke due to Blunt Traumatic Cerebrovascular Injury. Stroke 2020;51:353-360.
Go to original source... - Biffl WL, Castelo M, Dandan IS, et al. Exploring the role of endovascular interventions in blunt carotid and vertebral artery trauma. Am J Surg 2023;226:688-691.
Go to original source...
Go to PubMed... - Patel RR, Adam R, Maldjian C, et al. Cervical carotid artery dissection: current review of diagnosis and treatment. Cardiol Rev 2012;20:145-152.
Go to original source...
Go to PubMed... - Benninger DH, Gandjour J, Georgiadis D, et al. Benign long- -term outcome of conservatively treated cervical aneurysms due to carotid dissection. Neurology 2007;69:486-487.
Go to original source...
Go to PubMed... - Nedeltchev K, Bickel S, Arnold M, et al. R2-recanalization of spontaneous carotid artery dissection. Stroke 2009;40:499-504.
Go to original source...
Go to PubMed... - Lee VH, Brown RD Jr, Mandrekar JN, et al. Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006;67:1809-1812.
Go to original source...
Go to PubMed... - Nedeltchev K, Bickel S, Arnold M, et al. R2-recanalization of spontaneous carotid artery dissection. Stroke 2009;40:499-504.
Go to original source...
Go to PubMed... - Paraskevas KI, Batchelder AJ and Naylor AR. Fate of distal false aneurysms complicating internal carotid artery dissection: a systematic review. Eur J Vasc Endovasc Surg 2016;52:281-286.
Go to original source...
Go to PubMed... - van Laarhoven C, Arnold M, Danilova M, et al. Delayed development of aneurysmal dilatations in patients with extracranial carotid artery dissections. Eur J Vasc Endovasc Surg 2022;64:595-601.
Go to original source...
Go to PubMed... - Touzé E, Randoux B, Méary E, et al. Aneurysmal forms of cervical artery dissection: associated factors and outcome. Stroke 2001;32:418-423.
Go to original source...
Go to PubMed...
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.




