Carotid Dissection: A Clinical Review

Carotid artery dissection (CD) is an unusual pathological entity capable of producing devastating neurological deficits in affected patients. Symptoms include one or more of the clinical triad of headaches, oculosympathetic dysfunction, and retinal or cerebral ischemia. Cerebral angiography remains the gold standard for the diagnosis of carotid dissection. However, magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) are emerging as both sensitive and specific modalities for the diagnosis of carotid artery disease. Management of CD remains controversial; the efficacy of anticoagulation, the current standard of care for initial management of CD, has not been demonstrated in a clinical trial. The authors review management options to include anticoagulation, antiplatelet agents, endovascular stenting, and surgical management of carotid dissection.