Association Between Cervical Artery Dissection and Tortuosity – Review on Quantitative and Qualitative Assessment

Introduction: Cervical artery dissection is a common cause of ischemic stroke in young adults. The etiology of dissention is still a matter of debate. Several arguments suggest arterial tortuosity is associated with dissection.

Methods: Pubmed and Embase were searched to identify studies on the association between arterial tortuosity and cervical artery dissection. Studies were selected with the following terms: “cervical dissection” , “carotid dissection” “vertebral dissection”, “tortuosity”, “ tortuous” ,“redundancy” and “pseudoaneurysm”. Our review focused on the epidemiology of cervical tortuosity and dissection, pathophysiology, measurement of vessels tortuosity in dissected cervical arteries, the strength of association between tortuosity and dissection, clinical manifestation and management strategies.

Results: The prevalence of tortuosity in dissected cervical arteries was reported to be around 22%-65% while it is only around 8%-22% in non-dissected arteries. In tortuous cervical arteries elastin and tunica media degradation, increased wall stiffness, changes in hemodynamics as well as arterial wall inflammation might be associated with dissection. Arterial tortuosity index and vertebrobasilar artery deviation are used to measure the level of vessel tortuosity. Studies have shown an independent association between these two measurements and cervical artery dissection. Different anatomical variants of tortuosity such as loops, coils and kinks may have a different level of association with carotid artery dissection.
Pseudoaneurysms and intraluminal hematoma can occur as a result of dissection. Symptomatic patients with extracranial carotid and vertebral artery dissection are often treated with anticoagulant or antiplatelet agents, while patients with intracranial arterial dissection were often treated with antiplatelets only due to concerns of developing subarachnoid hemorrhage. Those who had recurrent ischemia, compromised cerebral blood flow, subarachnoid hemorrhage from intracerebral dissection or contraindication for antithrombotic agents are usually treated with surgical intervention.

Conclusion : Studies showed an independent association between cervical artery dissection and arterial tortuosity index and vertebrobasilar artery deviation.