Carotid Dissection

If you are experiencing neck and face pain, double vision, difficulty speaking, a droopy eyelid, or if you’re hearing a whooshing sound in one of your ears, you may have carotid dissection. At Mount Sinai, we are here to help. This condition is a common cause of stroke in young adults, typically between ages 35 and 50. We use sophisticated imaging techniques to develop an accurate diagnosis and an individualized treatment plan that takes into account your overall health.

About Carotid Dissection

Artery walls have three layers to provide strength, resilience, and flexibility to adapt to a constantly changing environment. Located on the sides of the neck, the carotid arteries bring blood to the brain and face.

A carotid dissection is a tear in the artery wall that allows blood to flow between the wall layers. It can cause problems in several ways. It can push against the true artery channel and block blood flow; cause pieces of clotted blood to block the smaller arteries in the brain, resulting in a stroke; or allow blood to leak into nearby tissue, creating a “pseudoaneurysm,” which can clot and block blood flow.

Carotid dissections usually develop without a clear cause (called spontaneous carotid artery dissection) or as a result of some sort of trauma (such as a car accident, sports injury, surgery, or chiropractic neck manipulation).

While it is unknown what causes carotid dissections, there are some conditions that increase your risk, such as fibromuscular dysplasia, Marfan's syndrome, Loeys-Dietz syndrome, and Ehlers Danlos Vascular type IV. People come to Mount Sinai from all over the world for treatment of these disorders.

If there is an underlying condition causing carotid dissection, you need to treat this condition to recover from the dissection. If you have a disorder that increases your risk for a carotid dissection, you should probably see a vascular specialist regularly.  

Carotid artery dissections cause a number of symptoms, including:

  • Weakness on one side of the body
  • Difficulty seeing or loss of vision in one eye (amaurosis fugax)
  • Facial droop
  • Problems with speech
  • Hearing a "whooshing" noise in one ear (pulsatile tinnitus)
  • Sudden head, face or neck pain with neurologic symptoms, such as a small pupil on one side or a drooping eyelid (Horner's syndrome)

If you suspect that you may be having a stroke, please go immediately to the nearest Emergency Room. 

Diagnosis and Treatment

The key to diagnosing a carotid dissection is imaging. Mount Sinai is a multidisciplinary institution with all the advanced imaging capabilities needed for an accurate diagnosis. We generally use these approaches to identify a possible carotid artery dissection:

  • Carotid artery duplex ultrasonography is a non-invasive ultrasound of the blood vessels that we can do right in our office. It cannot tell us if you have had a stroke.
  • Computerized tomography angiography (CTA) is a very accurate test that is rapidly becoming the "gold standard" in diagnosing carotid artery dissection. It uses contrast dye to highlight the arteries and 3D computerized tomography (CT) scans. The non-invasive test is fast and can tell if you’ve had a stroke, though it involves some radiation exposure.
  • Magnetic resonance angiography (MRA) is similar to the CTA in accuracy, ability to detect a stroke, and use of contrast dye and imaging scans, though it uses magnetic resonance imaging rather than computerized tomography. MRA doesn’t expose you to radiation, but it takes much longer than CTA.

At Mount Sinai, we develop a treatment plan for you based on your symptoms, risk factors, and any underlying disorder you might have. Our primary goal is to prevent a stroke. We may use medication and surgery.

Medication usually includes aspirin and other anti-platelet medications (e.g., clopidogrel, prasugrel, and ticagrelor). We might use blood-thinning medications such as heparin or warfarin instead of antiplatelet therapy.

Surgery typically involves a minimally invasive procedure under local anesthesia and mild sedation. Using a thin tube (catheter), we use stents with or without balloons to repair the artery.  A team of interventional cardiologists, vascular surgeons, and neurointerventionalists work together on the procedure.

The risk of recurrence of a spontaneous dissection is two percent the first year and one percent after that. If the dissection came as a result of trauma, you may have a 50 percent chance of stroke, though that will decrease over time. Our vascular specialists will follow you long-term after you finish treatment to monitor for progress, complications, and healing.