The diagnosis and management of supraaortic arterial dissections.

PURPOSE OF REVIEW: To review recent advances in understanding supraaortic arterial dissections and their diagnosis and management.

RECENT FINDINGS: Dissection of the supraaortic arteries, including the extracranial carotid and vertebral arteries and intracranial arteries, is increasingly identified as an important cause of stroke and subarachnoid hemorrhage. The most common cause likely involves minor trauma with preexisting arteriopathy. The imaging diagnosis of dissection is complicated by the wide range of pathological changes that occur after dissection. Modalities include ultrasound, magnetic resonance imaging and angiography, computed tomography angiography, and digital subtraction angiography. The choice of method is best tailored to each patient individually. Similarly, treatments may vary from antiplatelet medications to complex endovascular techniques. There are limited data to guide treating patients with strokes due to arterial dissections. Conservative management is likely optimal for most patients with cervical dissections, endovascular treatments being reserved for the rapidly deteriorating patient only. However, patients with subarachnoid hemorrhage due to rupture of a dissecting aneurysm require urgent endovascular or surgical treatment of the aneurysm.

SUMMARY: The diagnosis and management of supraaortic arterial dissections is complex, and a variable multidisciplinary approach will likely yield the best outcome.