Carotid Dissection: Features, Causes, Symptoms, Treatment, and Surgical Methods

What is Carotid Artery Dissection?

Carotid artery dissection (경동맥 박리) is a condition in which the wall of the carotid artery tears. The carotid artery is a major blood vessel that supplies blood to the brain, starting in the neck and extending to the brain. Carotid artery dissection is a condition in which a crack occurs in the inner wall of the blood vessel, causing blood to seep between the blood vessel walls. This can cause problems with blood flow, lead to blood clots, and in severe cases, cause a stroke. Carotid artery dissection is mainly caused by sudden trauma or structural problems in the blood vessels, but it can sometimes occur spontaneously without external stimuli.

Definition of Carotid Artery Dissection

Carotid artery dissection is a disease in which the inner wall (intima) of the carotid artery tears, allowing blood to penetrate between the blood vessel walls. This phenomenon can narrow the blood vessel or obstruct blood flow, and in severe cases, a blood clot can form, preventing proper blood flow. Carotid artery dissection can be a cause of acute stroke and can mainly occur in middle-aged and young adults.

Since the carotid artery plays an important role in supplying blood to the brain, dissection occurring in this blood vessel can seriously affect the blood supply to the brain. Carotid artery dissection is divided into two types: one is "true dissection" where the inner wall of the blood vessel tears and blood enters the blood vessel wall, and the other is "false dissection" where a false passage is formed between the intima and adventitia of the blood vessel.

Characteristics of Carotid Artery Dissection

Carotid artery dissection has various characteristics, and in most cases, it occurs acutely and is accompanied by sudden symptoms. The main characteristics are as follows:

1. Sudden and severe headache: A sudden severe headache or pain in the back of the neck may occur when carotid artery dissection occurs.
2. Unilateral symptoms: Symptoms usually appear on only one side. For example, numbness in one arm or leg, speech disorder, or visual impairment may occur.
3. Acute stroke: In severe cases of carotid artery dissection, if a blood clot occurs due to dissection and the blood vessel is blocked, it can cause an acute stroke.
4. Neck pain: Neck discomfort or pain is common. This may be pain caused by the tearing of the carotid artery wall.
5. Visual impairment: If blood supply is interrupted, vision may decrease or blur.

Causes of Carotid Artery Dissection

Carotid artery dissection can be caused by various factors, and the most important causes are as follows:

1. Trauma (physical injury): Impacts during traffic accidents or exercise, and strong pressure applied to the neck can cause carotid artery dissection. Physical impact can damage the carotid artery wall.
2. Other vascular diseases: Diseases that cause inflammation or weakening of blood vessels, such as hypertension, hyperlipidemia, and arteriosclerosis, can cause carotid artery dissection.
3. Other health conditions:

• Connective tissue disease: Connective tissue diseases such as Marfan syndrome and Ehlers-Danlos syndrome (autosomal dominant connective tissue disease) can weaken the blood vessel wall.
• Other vascular structural abnormalities: Some genetic characteristics or congenital vascular abnormalities can cause carotid artery dissection.
  4. Natural causes: Sometimes, carotid artery dissection can occur spontaneously without external physical damage. In this case, the blood vessel inner wall may weaken and tear spontaneously when stimulated.
  5. Adverse effects of medication: Some medications, especially anticoagulants or vasodilators, can cause carotid artery dissection.
  6. Smoking: Smoking negatively affects vascular health and may be associated with carotid artery dissection.

Symptoms of Carotid Artery Dissection

Symptoms of carotid artery dissection may vary depending on the location and severity of the dissection. The main symptoms are as follows:

1. Acute headache: Carotid artery dissection is mostly accompanied by a sudden and severe headache. This can be caused by changes in blood pressure due to dissection.
2. Neck pain: In carotid artery dissection, there may be uncomfortable pain or a stiff feeling in the neck. The pain may worsen when turning the neck or in certain postures.
3. Unilateral paralysis: If blood flow is obstructed by carotid artery dissection, paralysis or weakness in one arm or leg may appear. This is because blood flow to the brain is restricted.
4. Speech disorder: If carotid artery dissection obstructs blood flow to the brain, speech disorders or slurred speech may occur.
5. Visual impairment: Vision may become blurred, or vision may decrease in one eye. Visual impairment can accompany disruption of blood supply to the brain.
6. Dizziness and confusion: If the oxygen supply to parts of the brain is insufficient, dizziness or confusion may be felt.

Treatment Methods for Carotid Artery Dissection

Treatment for carotid artery dissection varies depending on the extent and location of the dissection, and there are generally two main treatment methods: medical treatment and surgical treatment.

1. Medical treatment

• Anticoagulants: If a blood clot forms due to carotid artery dissection, anticoagulants are used to prevent blood clot formation. Anticoagulants help prevent blood clot formation and remove existing blood clots.
• Antiplatelet agents: Prevents platelet aggregation and prevents blood clot formation. Aspirin is a representative drug.
• Antihypertensive drugs: If hypertension is the cause, drugs to lower blood pressure may be used.
• Analgesics: Analgesics may also be needed to relieve headaches and pain.

2. Surgical treatment

• Carotid artery stent placement: If the carotid artery is severely narrowed or the vascular damage due to dissection is significant, a stent may be inserted to expand the blood vessel. This method helps normalize blood flow.
• Carotid endarterectomy: Surgical methods to remove or clean the blood vessel inner wall may also be applied. This method is used when the carotid artery is severely damaged.

Prognosis and Management of Carotid Artery Dissection

The prognosis of carotid artery dissection varies depending on treatment and rapid response, but most people can recover with proper treatment. However, the potential impact of carotid artery dissection is very significant, so proper management is important.

Prognosis

• Risk of acute stroke: If a blood clot occurs or the cerebral blood vessel is blocked due to carotid artery dissection, it can lead to an acute stroke. This can cause neurological damage.
• Long-term effects: In severe cases, carotid artery dissection can cause permanent neurological damage or dysfunction. Therefore, prompt treatment is important.

Management methods

1. Regular checkups: After carotid artery dissection, regular medical checkups are necessary to check the vascular condition.
2. Maintain medication: Anticoagulants or blood pressure control medications should be taken consistently.
3. Healthy lifestyle habits: Avoiding smoking, maintaining a healthy diet, and regular exercise can help prevent recurrence of carotid artery dissection.
4. Stress management: Stress can negatively affect blood vessels, so it is good to learn how to manage stress.

Conclusion

Carotid artery dissection can manifest as symptoms such as acute headache, neck pain, visual impairment, and paralysis, and in severe cases, it can lead to a stroke. Treatment includes medical treatment and surgical treatment, and a good prognosis can be expected through appropriate treatment and management. Since early intervention is crucial in the early stages of carotid artery dissection, it is necessary to seek medical attention immediately if symptoms appear.