Vascular Dissection

Understanding Vascular Dissections: Causes, Symptoms & Treatment

If you or a loved one has been diagnosed with a vascular dissection, it’s completely understandable to feel overwhelmed or anxious. As neurosurgeons, we meet patients every day who are hearing these words for the first time — and we’re here to help you make sense of what it means and what comes next.

A vascular dissection is an injury to the wall of an artery. When this happens, blood can enter the layers of the artery wall, potentially leading to one of several serious outcomes: 

• A subarachnoid hemorrhage (bleeding around the brain)
• A pseudoaneurysm (a small, blister-like bulge in the artery wall)
•  Or a narrowing or complete blockage of the artery, which can limit blood flow and lead to an ischemic stroke.

Vascular dissections can occur in many arteries throughout the body, including coronary vessels (around the heart), the aorta, and the arteries in the head and neck (carotid and vertebral artery dissections). 

At New Jersey Brain and Spine, we specialize in treating the following types of vascular dissections: 

• Carotid arteries in the neck (patients have two of these arteries in the neck). This condition is rare, occurring in only 2 or 3 people per 100,000. 
• Vertebral arteries in the neck, (patients also have two of these arteries in the neck). 

Collectively, the four main arteries in the neck (carotid arteries and vertebral arteries) are called the cervical arteries. 

While these conditions are uncommon, they are true medical emergencies. Early diagnosis and proper care can make all the difference. 

Figure 1

Left: Carotid angiogram demonstrating a vascular dissection with resultant narrowing of the vessel (black arrow) with pseudoaneurysm formation (red arrow).  Right: Image obtained after stenting of injured vessel showing normalization of vessel diameter and diversion of flow from pseudoaneurysm (black arrows)

What Causes Vascular Dissections? 

Vascular dissections — especially those in the arteries of the neck — can happen for a variety of reasons. Sometimes, there’s an obvious cause, like an injury. Other times, they occur without warning, even during everyday activities.

Carotid artery dissections 

In the case of carotid artery dissections specifically, causes can include:

• Accidents (car or sports related) 
• Neck extension or rotation 
• Chiropractic manipulation 

Even something as routine as forceful coughing or blowing your nose can lead to a carotid artery dissection to occur. 

Certain people are more at risk of carotid artery dissections than others, including those who have: 

• Connective tissue disorders (such as Marfan syndrome, Ehlers-Danlos syndrome, Polycystic kidney disease)
• A family history of dissections
• Certain medical conditions (such as hypertension) 

Vertebral artery dissections 

In the case of vertebral artery dissections specifically, causes can include:

• Overextending the neck 
• CPR or other emergency resuscitation 
• Wrestling or lifting heavy objects 
• Car accidents 

Even sneezing, vomiting, or blowing your nose too hard can be a trigger in some cases. 

Risk factors include: 

• Being younger than 45 
• Smoking 
• High blood pressure 
• And certain underlying conditions like Ehlers-Danlos syndrome, fibromuscular dysplasia, polycystic kidney disease, and vasculitis 

What Are the Symptoms of a Vascular Dissection? 

Some people with a carotid or vertebral artery dissection experience no symptoms at all. Others may have symptoms that are sudden, scary, and serious. It’s important to recognize the warning signs and act quickly.

• Sudden severe pain in the eye, face, head, or neck 
• Neurological symptoms, such as balance issues or stroke-like symptoms 
• Vision problems or hearing problems 

If you or someone near you is experiencing these symptoms, seek medical care right away. Vascular dissections can be life-threatening, but with fast diagnosis and proper treatment, many patients go on to recover well.

How is a vascular dissection treated? 

Treatment for a vascular dissection depends on several factors — including where the dissection is located, how severe it is, and whether it’s causing symptoms like reduced blood flow or stroke.

In many cases, treatment can also be completed either with blood thinning agents i.e. aspirin, plavix or warfarin or with endovascular stenting of the vessel. Some dissections heal spontaneously without medical management. 

In more complex or serious cases, we may recommend endovascular treatment, which involves placing a stent inside the artery to help keep it open and restore normal blood flow. In rare cases, surgical repair may be needed. 

Even after successful treatment, we closely monitor our patients because vascular dissections can increase the risk of future vascular problems. Long-term care may include long-term blood pressure control and monitoring and/or anticoagulation therapy. 

At New Jersey Brain and Spine (NJBS) our highly specialized team offers expert, compassionate treatment to patients with vascular dissections and those at risk of future vascular problems, ensuring the best outcomes and quality of life. 

Case Study: Successful Vascular Dissection Treatment

Shantae, A 45-year-old previously healthy female, presented to the emergency department with sudden onset severe neck pain and headache that she first noticed while strength training earlier that morning. She had mild dizziness when standing, but no neurological deficits upon exam. Upon receiving an MRI/MRA of her neck and brain, a right vertebral artery dissection with intramural hematoma was found.

Upon consultation with the vascular surgeons at New Jersey Brain and Spine, it was determined to start her on anticoagulation medication and restrict her activity (no heavy lifting or contact sports). After 6 months, anticoagulation was discontinued and the patient fully recovered. 

Why Choose NJBS for Vascular Dissection Treatment? 

New Jersey Brain and Spine is one of the top 10 neurosurgery practices in the country and a leading destination for patients with carotid and vertebral artery dissections. 

Please keep in mind that early diagnosis and timely treatment are key to improving outcomes with vascular dissections. 

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If you are experiencing any symptoms that concern you, contact New Jersey Brain and Spine today.