Cervical artery dissection

Cervical artery dissection (CAD) or tear in the arteries of the neck—the carotid or vertebral arteries—accounts for only 2% of all ischaemic strokes. However, it is an important cause of stroke in young and middle-aged patients, accounting for 8% to 25% of stroke in patients <45 years of age.

It is unclear what the natural history of CAD is, as all patients diagnosed receive treatments such as antithrombotic therapies or thrombolysis. Some studies suggest that patients presenting with stroke or TIA and CAD have a risk of secondary stroke of around 15%, while others report a much lower rate at 3%.

Embolism from thrombus formation at the dissection site is thought to main way CAD leads to stroke. This is supported by transcranial Doppler studies showing cerebral microemboli soon after dissection, and by the brain imaging results suggesting an embolic pattern.

The risk of recurrent stroke and the pathogenesis have led to clinicians to advocate for preventive measures.

For current research and evidence-based recommendations see our Clinical Guidelines.