Vol 55, No 1 (2021)
Research Paper
Published online: 2020-10-12

open access

Page views 1508
Article views/downloads 724
Get Citation

Connect on Social Media

Connect on Social Media

Internal carotid and vertebral artery dissections — a comparison of clinical, radiological and prognostic characteristics

Justyna Kos1, Michał Kos1, Jacek Jaworski1, Véronique Petit1, Katarzyna Wojtal2, Konrad Rejdak1
Pubmed: 33047785
Neurol Neurochir Pol 2021;55(1):52-58.


Aim of study. To examine whether baseline characteristics, potential risk factors, clinical symptoms, radiological presentation, and long-term outcomes differ between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD).

Clinical rationale for study. Cervical artery dissection (CeAD) is a major cause of cerebral ischaemia in young adults. Its clinical course is highly variable, resulting in challenges in making a proper diagnosis.

Methods. We performed a retrospective analysis of 31 patients (mean age 42.2 years) with CeAD (18 with ICAD, 13 with VAD) treated in our neurology department from 2008 to 2018. Appropriate imaging confirmed the diagnosis of CeAD.

Results. Patients with ICAD presented Horner syndrome significantly more often (44.4% vs 7.6%; p = 0.04). Patients with VAD more often had ischaemic events (ischaemic stroke, TIA or transient blindness) (84.6% vs 44.6%; p = 0.0032). Ischaemic stroke was more severe in patients with ICAD [(median NIHSS 6, interquartile range 4–12) vs VAD (median NIHSS 4, interquartile range 1.5–5.5), p = 0,03]. Occlusion occurred more often in patients with VAD (69.2% vs 22.2%; p = 0.013). Most patients had a favourable outcome (mRS 0–2).

Conclusions and clinical implications. In a series of patients with CeAD, we observed significant differences between VAD and ICAD in terms of clinical symptoms and radiological features.

Article available in PDF format

View PDF Download PDF file


  1. Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015; 11: 157–164.
  2. Blum CA, Yaghi S. Cervical Artery Dissection: A Review of the Epidemiology, Pathophysiology, Treatment, and Outcome. Arch Neurosci. 2015; 2(4).
  3. Mohan IV. Current optimal assessment and management of carotid and vertebral spontaneous and traumatic dissection. Angiology. 2014; 65(4): 274–283.
  4. Robertson JJ, Koyfman A. Cervical Artery Dissections: A Review. J Emerg Med. 2016; 51(5): 508–518.
  5. Schelfaut D, Dhondt E, De Raedt S, et al. Carotid artery dissection: three cases and a review of the literature. Eur J Emerg Med. 2012; 19(3): 181–187.
  6. Taoussi N, Alghamdi AJ, Bielewicz J, et al. Traumatic bilateral dissection of cervical internal carotid artery in the wake of a car accident: A case report. Neurol Neurochir Pol. 2017; 51(5): 432–438.
  7. Debette S, Grond-Ginsbach C, Bodenant M, et al. Cervical Artery Dissection Ischemic Stroke Patients (CADISP) Group. Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology. 2011; 77(12): 1174–1181.
  8. Baumgartner RW, Arnold M, Baumgartner I, et al. Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings. Neurology. 2001; 57(5): 827–832.
  9. Robertson JJ, Koyfman A, Robertson JJ, et al. Cervical Artery Dissections: A Review. J Emerg Med. 2016; 51(5): 508–518.
  10. Ben Hassen W, Machet A, Edjlali-Goujon M, et al. Imaging of cervical artery dissection. Diagn Interv Imaging. 2014; 95(12): 1151–1161.
  11. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50(12): e344–e418.
  12. Markus HS, Levi C, King A, et al. Cervical Artery Dissection in Stroke Study (CADISS) Investigators. 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(6): 657–664.
  13. von Babo M, De Marchis GM, Sarikaya H, et al. Differences and similarities between spontaneous dissections of the internal carotid artery and the vertebral artery. Stroke. 2013; 44(6): 1537–1542.
  14. Lee VH, Brown RD, Mandrekar JN, et al. Incidence and outcome of cervical artery dissection: a population-based study. Neurology. 2006; 67(10): 1809–1812.
  15. Lyrer PA, Brandt T, Metso TM, et al. Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) Study Group. Clinical import of Horner syndrome in internal carotid and vertebral artery dissection. Neurology. 2014; 82(18): 1653–1659.
  16. Metso TM, Debette S, Grond-Ginsbach C, et al. Age-dependent differences in cervical artery dissection. J Neurol. 2012; 259(10): 2202–2210.
  17. von Sarnowski B, Schminke U, Grittner U, et al. Cervical artery dissection in young adults in the stroke in young Fabry patients (sifap1) study. Cerebrovasc Dis. 2015; 39(2): 110–121.
  18. De Giuli V, Grassi M, Lodigiani C, et al. Italian Project on Stroke in Young Adults Investigators. Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults. JAMA Neurol. 2017; 74(5): 512–518.
  19. Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases. 2015; 3(5): 418–429.
  20. Dziewas R, Konrad C, Dräger B, et al. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 2003; 250(10): 1179–1184.
  21. Debette S. Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts? Curr Opin Neurol. 2014; 27(1): 20–28.
  22. Debette S, Metso T, Pezzini A, et al. Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) Group. Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation. 2011; 123(14): 1537–1544.
  23. Thomas LC, Rivett DA, Parsons M, et al. Risk factors and clinical features of craniocervical arterial dissection. Man Ther. 2011; 16(4): 351–356.
  24. Sheikh HU. Headache in Intracranial and Cervical Artery Dissections. Curr Pain Headache Rep. 2016; 20(2): 8.
  25. Caplan LR. Dissections of brain-supplying arteries. Nat Clin Pract Neurol. 2008; 4(1): 34–42.
  26. Hülsbömer HB, Steinke W. [Taste disorder caused by carotid artery dissection]. Nervenarzt. 2001; 72(8): 629–631.
  27. Mokri B, Silbert PL, Schievink WI, et al. Cranial nerve palsy in spontaneous dissection of the extracranial internal carotid artery. Neurology. 1996; 46(2): 356–359.
  28. Lui F, Tadi P, Anilkumar AC. Wallenberg Syndrome. StatPearls Publishing. ; 2019.
  29. Lee JS, Yong SW, Bang OhY, et al. Comparison of spontaneous intracranial vertebral artery dissection with large artery disease. Arch Neurol. 2006; 63(12): 1738–1744.
  30. Ali MS, Amenta PS, Starke RM, et al. Intracranial vertebral artery dissections: evolving perspectives. Interv Neuroradiol. 2012; 18(4): 469–483.
  31. Zhang G, Chen Z. Medical and Interventional Therapy for Spontaneous Vertebral Artery Dissection in the Craniocervical Segment. Biomed Res Int. 2017; 2017: 7859719.
  32. Spasojević G, Vujmilović S, Vujković Z, et al. Internal carotid and vertebral arteries diameters and their interrelationships to sex and left/right side. Folia Morphol (Warsz). 2020; 79(2): 219–225.

Neurologia i Neurochirurgia Polska