Cervical artery dissection is a cervicocephalic arterial wall injury in the carotid or vertebral arteries that produces an intramural hematoma, luminal stenosis or pseudoaneurysm, and risk of thromboembolic ischemic stroke.
Ask a research question about Cervical Artery Dissection. OpenScientist will conduct autonomous deep research using the Disorder Mechanisms Knowledge Base and PubMed literature (typically 10-30 minutes).
Do not include personal health information in your question. Questions and results are cached in your browser's local storage.
name: Cervical Artery Dissection
creation_date: "2026-05-06T11:59:10Z"
updated_date: "2026-05-06T13:06:21Z"
category: Complex
description: >-
Cervical artery dissection is a cervicocephalic arterial wall injury in the
carotid or vertebral arteries that produces an intramural hematoma, luminal
stenosis or pseudoaneurysm, and risk of thromboembolic ischemic stroke.
disease_term:
preferred_term: cervical artery dissection
term:
id: MONDO:0006061
label: cervical artery dissection
parents:
- Vascular Disorder
- Cerebrovascular Disease
synonyms:
- Cervicocephalic artery dissection
- CeAD
- Carotid or vertebral artery dissection
- Extracranial carotid and vertebral artery dissection
has_subtypes:
- name: Carotid Artery Dissection
description: >-
Cervical artery dissection involving the extracranial carotid artery.
- name: Vertebral Artery Dissection
description: >-
Cervical artery dissection involving the extracranial vertebral artery.
- name: Spontaneous Cervical Artery Dissection
description: >-
Dissection without major trauma, often occurring in the setting of
multifactorial arterial-wall susceptibility and minor mechanical triggers.
- name: Traumatic Cervical Artery Dissection
description: >-
Dissection temporally associated with clinically significant neck or head
trauma.
pathophysiology:
- name: Arterial Wall Susceptibility
description: >-
Multifactorial arterial-wall susceptibility, including connective-tissue
dysplasia, systemic vasculopathy, and rare monogenic connective-tissue
disease, lowers the threshold for cervical arterial wall injury.
cell_types:
- preferred_term: fibroblast
term:
id: CL:0000057
label: fibroblast
biological_processes:
- preferred_term: extracellular matrix organization
term:
id: GO:0030198
label: extracellular matrix organization
modifier: ABNORMAL
evidence:
- reference: PMID:38791244
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The clinical, radiological, and histological characteristics of systemic
vasculopathy and undifferentiated connective tissue dysplasia are present
in up to 70% of individuals with sporadic CeAD.
explanation: >-
This supports connective-tissue and systemic-vasculopathy susceptibility
as common background biology for sporadic cervical artery dissection.
- reference: PMID:38791244
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Monogenic heritable connective tissue diseases account for fewer than 5%
of cases of CeAD.
explanation: >-
This supports rare monogenic connective-tissue disease as a recognized but
minority cause of cervical artery dissection susceptibility.
downstream:
- target: Arterial Wall Tear and Intramural Hematoma
description: >-
A susceptible cervical arterial wall is more likely to dissect after
mechanical stress or spontaneous mural injury.
- name: Arterial Wall Tear and Intramural Hematoma
description: >-
A tear in the intima or bleeding within the arterial wall separates vessel
wall layers, creating an intramural hematoma that narrows the lumen or forms
a pseudoaneurysm.
cell_types:
- preferred_term: endothelial cell
term:
id: CL:0000115
label: endothelial cell
biological_processes:
- preferred_term: response to wounding
term:
id: GO:0009611
label: response to wounding
modifier: INCREASED
evidence:
- reference: PMID:25684164
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
We included patients with extracranial carotid and vertebral dissection
with onset of symptoms within the past 7 days.
explanation: >-
The CADISS trial population confirms extracranial carotid and vertebral
dissection as the clinical substrate for this disorder; the abstract does
not itself describe the arterial wall microanatomy, so this is partial
support.
- reference: PMID:37957581
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In the acute and subacute stage, the typical sign detection of intramural
hematoma and Grade II enhancement revealed by HR-MRI was higher than the
observations in the chronic stage (P = 0.000/0.000/0.016), while there
was no significant difference by MRA (P = 0.902).
explanation: >-
Vessel-wall imaging directly supports intramural hematoma as an acute and
subacute imaging sign of cervicocranial artery dissection.
downstream:
- target: Thromboembolism and Cerebral Ischemia
description: >-
The dissected arterial wall and altered lumen promote local thrombosis,
stenosis, occlusion, and embolization.
- name: Molecular Stress and Vascular Remodeling Signatures
description: >-
Peripheral-blood transcriptomic changes in CeAD implicate molecular stress,
senescence-associated signaling, mitochondrial dysfunction, and
epithelial-mesenchymal plasticity as candidate mechanisms that may accompany
arterial-wall vulnerability and remodeling.
biological_processes:
- preferred_term: cellular senescence
term:
id: GO:0090398
label: cellular senescence
modifier: INCREASED
- preferred_term: mitochondrial organization
term:
id: GO:0007005
label: mitochondrion organization
modifier: ABNORMAL
evidence:
- reference: PMID:38791244
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
We found potential correlations between CeAD and the dysregulation of
genes linked to nucleolar stress, senescence-associated secretory
phenotype, mitochondrial malfunction, and epithelial-mesenchymal
plasticity.
explanation: >-
This transcriptomic study supports candidate molecular stress and vascular
remodeling pathways associated with CeAD.
downstream:
- target: Arterial Wall Tear and Intramural Hematoma
description: >-
Molecular stress and remodeling signatures may contribute to arterial-wall
vulnerability and impaired repair.
- name: Thromboembolism and Cerebral Ischemia
description: >-
Damaged arterial endothelium and disturbed flow promote local thrombosis and
embolization to cerebral arteries.
cell_types:
- preferred_term: platelet
term:
id: CL:0000233
label: platelet
biological_processes:
- preferred_term: blood coagulation
term:
id: GO:0007596
label: blood coagulation
modifier: INCREASED
evidence:
- reference: PMID:25684164
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Extracranial carotid and vertebral artery dissection is an important cause
of stroke, especially in young people.
explanation: >-
This directly supports cervical artery dissection as a cause of ischemic
cerebrovascular events.
phenotypes:
- name: Headache
category: Neurologic
frequency: COMMON
phenotype_term:
preferred_term: Headache
term:
id: HP:0002315
label: Headache
evidence:
- reference: PMID:25684164
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The major presenting symptoms were stroke or transient ischaemic attack
(n=224) and local symptoms (headache, neck pain, or Horner's syndrome;
n=26).
explanation: >-
Headache is explicitly listed as a local presenting symptom in the CADISS
cervical dissection cohort.
- name: Neck Pain
category: Neurologic
frequency: COMMON
phenotype_term:
preferred_term: Neck pain
term:
id: HP:0030833
label: Neck pain
evidence:
- reference: PMID:25684164
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The major presenting symptoms were stroke or transient ischaemic attack
(n=224) and local symptoms (headache, neck pain, or Horner's syndrome;
n=26).
explanation: >-
Neck pain is included among local presenting symptoms in symptomatic
cervical artery dissection.
- name: Ischemic Stroke
category: Neurologic
frequency: OCCASIONAL
phenotype_term:
preferred_term: Ischemic stroke
term:
id: HP:0002140
label: Ischemic stroke
evidence:
- reference: PMID:25684164
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Extracranial carotid and vertebral artery dissection is an important cause
of stroke, especially in young people.
explanation: >-
The trial background directly supports stroke as a major clinical
consequence of cervical artery dissection.
- name: Transient Ischemic Attack
category: Neurologic
frequency: COMMON
phenotype_term:
preferred_term: Transient ischemic attack
term:
id: HP:0002326
label: Transient ischemic attack
evidence:
- reference: PMID:25684164
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The major presenting symptoms were stroke or transient ischaemic attack
(n=224) and local symptoms (headache, neck pain, or Horner's syndrome;
n=26).
explanation: >-
The CADISS cohort explicitly identifies transient ischemic attack among
major presenting symptoms in symptomatic cervical dissection.
- name: Horner Syndrome
category: Neurologic
frequency: OCCASIONAL
phenotype_term:
preferred_term: Horner syndrome
term:
id: HP:0002277
label: Horner syndrome
evidence:
- reference: PMID:25684164
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The major presenting symptoms were stroke or transient ischaemic attack
(n=224) and local symptoms (headache, neck pain, or Horner's syndrome;
n=26).
explanation: >-
Horner syndrome is explicitly listed among local presenting symptoms.
treatments:
- name: Antithrombotic Therapy
description: >-
Antiplatelet or anticoagulant therapy is used to reduce recurrent
thromboembolic events in appropriate patients.
treatment_term:
preferred_term: Pharmacotherapy
term:
id: NCIT:C15986
label: Pharmacotherapy
therapeutic_agent:
- preferred_term: aspirin
term:
id: CHEBI:15365
label: acetylsalicylic acid
- preferred_term: warfarin
term:
id: CHEBI:10033
label: warfarin
evidence:
- reference: PMID:25684164
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
We found no difference in efficacy of antiplatelet and anticoagulant drugs
at preventing stroke and death in patients with symptomatic carotid and
vertebral artery dissection but stroke was rare in both groups, and much
rarer than reported in some observational studies.
explanation: >-
The randomized CADISS trial supports antiplatelet or anticoagulant
antithrombotic management, without evidence that one strategy is superior.
- reference: PMID:34746432
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Based on evidence from two phase 2 RCTs that have shown no difference
between the benefits and risks of anticoagulants versus antiplatelets in
the acute phase of symptomatic EAD, we strongly recommend that clinicians
can prescribe either option.
explanation: >-
The ESO guideline supports either anticoagulant or antiplatelet therapy in
acute symptomatic extracranial artery dissection.
- name: Aspirin Therapy
description: >-
Aspirin is one antiplatelet option for cervical artery dissection, but
TREAT-CAD did not prove aspirin non-inferior to vitamin K antagonist
anticoagulation.
treatment_term:
preferred_term: aspirin pharmacotherapy
term:
id: NCIT:C15986
label: Pharmacotherapy
therapeutic_agent:
- preferred_term: aspirin
term:
id: CHEBI:15365
label: acetylsalicylic acid
evidence:
- reference: PMID:33765420
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
Our findings did not show that aspirin was non-inferior to vitamin K
antagonists in the treatment of cervical artery dissection.
explanation: >-
TREAT-CAD directly evaluates aspirin in cervical artery dissection but
qualifies its role because non-inferiority to vitamin K antagonists was
not shown.
- name: Intravenous Thrombolysis for Acute Ischemic Stroke
description: >-
Intravenous alteplase is recommended for eligible patients with extracranial
artery dissection and acute ischemic stroke within the standard stroke
treatment window.
treatment_term:
preferred_term: thrombolytic therapy
term:
id: NCIT:C15338
label: Thrombolytic Therapy
therapeutic_agent:
- preferred_term: alteplase
term:
id: NCIT:C39607
label: Alteplase
evidence:
- reference: PMID:34746432
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In EAD patients with acute ischemic stroke, we recommend using intravenous
thrombolysis (IVT) with alteplase within 4.5 hours of onset if standard
inclusion/exclusion criteria are met, and mechanical thrombectomy in
patients with large vessel occlusion of the anterior circulation.
explanation: >-
The ESO guideline directly supports IV alteplase for eligible
extracranial artery dissection patients with acute ischemic stroke.
- name: Mechanical Thrombectomy
description: >-
Mechanical thrombectomy is used in eligible cervical-artery-dissection
patients when acute ischemic stroke is complicated by anterior-circulation
large-vessel occlusion.
treatment_term:
preferred_term: thrombectomy for stroke
term:
id: NCIT:C191635
label: Thrombectomy for Stroke
evidence:
- reference: PMID:34746432
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In EAD patients with acute ischemic stroke, we recommend using intravenous
thrombolysis (IVT) with alteplase within 4.5 hours of onset if standard
inclusion/exclusion criteria are met, and mechanical thrombectomy in
patients with large vessel occlusion of the anterior circulation.
explanation: >-
The ESO guideline directly supports thrombectomy for extracranial artery
dissection with anterior-circulation large-vessel occlusion.
Target disease: Cervical Artery Dissection (carotid and/or vertebral artery dissection, typically extracranial).
Category: Complex (multifactorial; small monogenic fraction).
Evidence note: Many retrieved full texts/abstracts did not include PMIDs in-line; therefore, citations are given to the retrieved sources by evidence IDs plus DOI/URL and publication date when available.
| Domain | Key finding (with numbers) | Study/source (short) | Publication year | URL |
|---|---|---|---|---|
| Incidence and age | Extracranial artery dissection incidence ~2.6–3.0 per 100,000/year; mean age for EAD ~44 years (debette2021esoguidelinefor pages 2-4) | ESO guideline | 2021 | https://doi.org/10.1177/23969873211046475 |
| Proportion of ischemic presentations | EAD complicated by cerebral ischemia in about two thirds to three quarters of series (debette2021esoguidelinefor pages 1-2); in a real-world cohort, ischemic symptoms in 43/62 (69%) with TIA 16%, minor stroke 27%, major stroke 25% (lodato2025tenyearoutcomesof pages 5-9) | ESO guideline; Lodato et al. | 2021; 2025 | https://doi.org/10.1177/23969873211046475; https://doi.org/10.3390/jcm14196836 |
| Recanalization and aneurysm evolution | Stenosis recanalizes in 33–90% within 6 months; dissecting aneurysms resolve/decrease in 40–50%; CADISS-related data: 24/264 aneurysms at baseline vs 36/248 at 3 months, with 12 persistent and 24 new (debette2021esoguidelinefor pages 2-4) | ESO guideline | 2021 | https://doi.org/10.1177/23969873211046475 |
| TREAT-CAD outcomes | Primary endpoint: 23.1% (21/91) aspirin vs 14.6% (12/82) VKA; ischemic stroke: 7/91 (7.7%) vs 0/82; major extracranial hemorrhage: 0 vs 1/82 (1.2%); no deaths (engelter2021aspirinversusanticoagulation pages 7-11) | TREAT-CAD RCT | 2021 | https://doi.org/10.1016/S1474-4422(21)00044-2 |
| ESO guideline key recommendations | Acute symptomatic EAD: IV alteplase within 4.5 h if eligible; mechanical thrombectomy for anterior-circulation LVO; either anticoagulants or antiplatelets may be prescribed in acute symptomatic EAD; expert consensus supports DOACs as possible VKA substitutes and short-term DAPT for TIA/minor stroke (debette2021esoguidelinefor pages 42-43, debette2021esoguidelinefor pages 37-41) | ESO guideline | 2021 | https://doi.org/10.1177/23969873211046475 |
| HRMR-VWI vs MRA findings | In 34 patients/38 vessels, HRMR-VWI detected typical signs in all acute/subacute patients; intimal flap/double-lumen detection superior to MRA (P=0.012); IMH and grade II enhancement higher in acute/subacute vs chronic stage (P=0.000/0.000/0.016); MRA stage differences not significant (P=0.902) (ma2023imaginginvestigationof pages 1-2, ma2023imaginginvestigationof pages 6-9) | Ma et al. imaging study | 2023 | https://doi.org/10.1186/s12880-023-01133-z |
| STOP-CAD TCD survey | 29/58 centers (50%) routinely used TCD; European vs North American use 76.4% vs 34.3% (P=0.007); after HITS detection, 32.8% switched from antiplatelet to anticoagulation; 20.7% switched DAPT to anticoagulation; 12.1% switched SAPT to anticoagulation (guo2024applicationoftranscranial pages 1-2, guo2024applicationoftranscranial pages 4-4, guo2024applicationoftranscranial pages 3-3) | Guo et al. STOP-CAD survey | 2024 | https://doi.org/10.1002/neo2.70004 |
| Long-term outcome cohort | Median follow-up 78 months: recurrent ischemic stroke in 2 patients (4%), both within 12 months; 10-year overall survival 71%; 10-year stroke/death-free survival 70%; medically treated subgroup stroke/death-free survival 86% with anticoagulation vs 67% with antiplatelets (lodato2025tenyearoutcomesof pages 5-9) | Lodato et al. cohort | 2025 | https://doi.org/10.3390/jcm14196836 |
Table: This table compiles the main quantitative findings for cervical artery dissection across epidemiology, presentation, imaging, treatment trials, guideline recommendations, implementation surveys, and long-term outcomes. It is useful as a quick-reference evidence summary anchored to the retrieved context IDs.
Key guideline recommendation tables (ESO) were also retrieved as images (debette2021esoguidelinefor media df12240a, debette2021esoguidelinefor media 106e3d8a).
Cervical artery dissection (CeAD; also “cervical artery dissection/CAD”) is defined by intramural hematoma in the wall of the cervical portion of the internal carotid artery and/or vertebral artery, often producing stenosis/occlusion or a dissecting aneurysm and predisposing to thromboembolism and ischemic stroke. (engelter2021cervicalandintracranial pages 1-2, debette2021esoguidelinefor pages 1-2)
Direct quote (definition hallmark): the Engelter et al. review describes CeAD as having the “hallmark intramural hematoma of the cervical portion of the internal carotid or vertebral arteries.” (engelter2021cervicalandintracranial pages 1-2)
The European Stroke Organisation (ESO) guideline uses the term extracranial artery dissection (EAD) to refer to dissections of the cervical carotid or vertebral arteries and contrasts this with intracranial artery dissection (IAD); EAD/IAD are confirmed by characteristic radiologic signs (mural hematoma, dissecting aneurysm, long tapering stenosis, intimal flap, double lumen, etc.). (debette2021esoguidelinefor pages 2-4)
The knowledge base content here is derived from aggregated disease-level resources (ESO guideline; systematic reviews) and patient cohorts / pragmatic studies (single-center case series, retrospective cohort, multicenter survey, RCT). (debette2021esoguidelinefor pages 2-4, filip2023cervicalarterydissections—a pages 1-2, ma2023imaginginvestigationof pages 1-2, guo2024applicationoftranscranial pages 1-2, engelter2021aspirinversusanticoagulation pages 7-11, lodato2025tenyearoutcomesof pages 5-9)
CeAD occurs when a tear in the arterial wall or vasa vasorum results in an intramural hematoma and possibly a false lumen, which can cause luminal stenosis/occlusion and promote local thrombus and artery-to-artery embolism. (filip2023cervicalarterydissections—a pages 1-2, debette2021esoguidelinefor pages 1-2)
CeAD can be spontaneous or traumatic, and minor cervical strain/trauma (including whiplash-type mechanisms) is commonly reported as a trigger. (filip2023cervicalarterydissections—a pages 1-2)
Predisposing conditions include fibromuscular dysplasia and heritable connective tissue disorders such as Ehlers–Danlos syndrome and Marfan syndrome. (filip2023cervicalarterydissections—a pages 1-2, blum2015cervicalarterydissection pages 1-3)
Associated factors reported across clinical reviews and cohorts include hypertension and migraine. (filip2023cervicalarterydissections—a pages 1-2, blum2015cervicalarterydissection pages 1-3)
No specific genetic or environmental protective factors were identified in the retrieved evidence set.
The retrieved evidence supports a multifactorial model where an underlying predisposition affecting arterial wall integrity (genetic and/or connective tissue phenotype) may interact with mechanical stressors (minor trauma/exertion) to precipitate dissection, but formal GxE effect-size estimates were not available in the retrieved texts. (filip2023cervicalarterydissections—a pages 1-2, shlapakova2024peripheralbloodgene pages 1-2, nino2024thenaturalhistory pages 84-88)
CeAD commonly presents with local symptoms (pain, Horner syndrome, cranial nerve palsy) and/or cerebral ischemia (TIA/stroke). In ESO-cited series, ischemia complicates EAD in about two thirds to three quarters of patients. (debette2021esoguidelinefor pages 1-2)
HPO suggestions (non-exhaustive):
* Headache — HP:0002315
Neck pain — HP:0000467
Horner syndrome — HP:0000005
Transient ischemic attack — HP:0002326 (approximate)
Ischemic stroke — HP:0002140
Cranial nerve palsy — HP:0001290 (broad)
Vertigo (posterior circulation) — HP:0002321
Ataxia — HP:0001251*
In a real-world cohort of 62 patients, 69% presented with ischemic manifestations (16% TIA; 27% minor stroke; 25% major stroke). (lodato2025tenyearoutcomesof pages 5-9)
Direct QoL instrument data (e.g., EQ-5D, SF-36) were not captured in the retrieved evidence set; however, CeAD is highlighted as a leading cause of stroke in younger adults and thus a major potential driver of disability. (engelter2021cervicalandintracranial pages 1-2, debette2021esoguidelinefor pages 1-2)
A minority of CeAD is attributable to monogenic heritable connective tissue disorders.
Direct quote (proportion): “Monogenic heritable connective tissue diseases account for fewer than 5% of cases of CeAD.” (Shlapakova et al., 2024) (shlapakova2024peripheralbloodgene pages 1-2)
Examples of single-gene disorders plausibly increasing risk include connective tissue disorder genes such as FBN1 (Marfan) and COL3A1 (vascular Ehlers–Danlos), as well as TGF-β pathway genes in Loeys–Dietz spectrum (e.g., TGFBR1/2, SMAD2/3, TGFB2/3). (maly2025carotidarterydissection pages 2-4, nino2024thenaturalhistory pages 84-88)
GWAS signals in CeAD often map to non-coding variants influencing transcription/RNA processing. Reported CeAD-associated genes/loci include PHACTR1 and LRP1, among others (e.g., PLCE1, IRAG1). (shlapakova2024peripheralbloodgene pages 2-4)
A mechanistic study of the pleiotropic vascular-risk locus LRP1 rs11172113 supports an allele-specific regulatory mechanism in smooth muscle cells leading to extracellular matrix remodeling and altered signaling:
Direct quote (key abstract statement): “Multitrait colocalization analyses pointed at rs11172113 as the most likely causal variant in LRP1 for fibromuscular dysplasia, migraine, pulse pressure, and spontaneous coronary artery dissection.” (Liu et al., Circulation Research, 2024) (liu2024lrp1repressionby pages 1-2)
Mechanistically, the study shows LRP1 perturbation in iPSC-derived smooth muscle cells affects extracellular matrix composition and potentiates canonical TGF-β/SMAD2/3 signaling. (liu2024lrp1repressionby pages 11-12, liu2024lrp1repressionby pages 1-2)
Peripheral blood bulk RNA-seq (19 CeAD vs 18 controls) identified differential expression and pathway signals consistent with systemic stress and vascular biology.
Direct quote (key molecular pathways): “We found potential correlations between CeAD and the dysregulation of genes linked to nucleolar stress, senescence-associated secretory phenotype, mitochondrial malfunction, and epithelial–mesenchymal plasticity.” (Shlapakova et al., 2024) (shlapakova2024peripheralbloodgene pages 1-2)
GO biological processes (examples): * extracellular matrix organization (GO:0030198) (supported conceptually by ECM remodeling evidence) (liu2024lrp1repressionby pages 11-12, liu2024lrp1repressionby pages 1-2) * transforming growth factor beta receptor signaling pathway (GO:0007179) (liu2024lrp1repressionby pages 11-12, liu2024lrp1repressionby pages 1-2) * smooth muscle cell proliferation/migration (GO:0048660/GO:0016477) (liu2024lrp1repressionby pages 1-2)
Cell Ontology (CL) (examples): * vascular smooth muscle cell — CL:0000192 (liu2024lrp1repressionby pages 11-12, liu2024lrp1repressionby pages 1-2) * endothelial cell — CL:0000115 (implicated in vascular integrity discussions; not directly profiled here)
The retrieved evidence emphasizes mechanical neck stress/trauma and vascular risk factors (e.g., hypertension) rather than specific toxins or occupational exposures. (filip2023cervicalarterydissections—a pages 1-2, blum2015cervicalarterydissection pages 1-3)
Specific pathogens were not established as causal in the retrieved evidence. However, reviews note infection has been described as a risk factor in broader literature; the retrieved excerpted evidence did not provide quantitative estimates. (shlapakova2024peripheralbloodgene pages 2-4, nino2024thenaturalhistory pages 84-88)
UBERON suggestions:
* internal carotid artery — UBERON:0001645
vertebral artery — UBERON:0001646
cervical region vasculature — (composite; ontology-dependent)
Unilateral is common; bilateral and multi-vessel dissections occur (ESO: multiple cervical arteries involved in ~15–20% of EAD). (debette2021esoguidelinefor pages 2-4)
Often acute/subacute; antithrombotic therapy is recommended to start immediately after diagnosis due to early stroke risk. (engelter2021cervicalandintracranial pages 1-2)
Recanalization is common: ESO guideline reports stenosis recanalization 33–90% within 6 months; dissecting aneurysms resolve/decrease in 40–50% (with dynamic evolution in CADISS follow-up). (debette2021esoguidelinefor pages 2-4)
Most CeAD appears multifactorial/polygenic with rare monogenic CTD contribution (<5%). (shlapakova2024peripheralbloodgene pages 1-2, nino2024thenaturalhistory pages 84-88)
ESO diagnostic confirmation includes mural hematoma, dissecting aneurysm, long tapering stenosis, intimal flap, double lumen, or characteristic occlusion patterns. (debette2021esoguidelinefor pages 2-4)
High-resolution MR vessel wall imaging (HRMR-VWI) provides improved detection of direct wall signs (intimal flap/double lumen/intramural hematoma) and enables staging and quantitative vessel-wall metrics.
In a 2023 BMC Medical Imaging study (34 patients; 38 vessels), intimal flap/double-lumen detection was more common on HRMR-VWI than MRA (P = 0.012), and intramural hematoma and grade II enhancement were more often detected in acute/subacute vs chronic stages. (ma2023imaginginvestigationof pages 1-2, ma2023imaginginvestigationof pages 6-9)
Direct quote: HRMR-VWI “visualizes vessel walls, thereby effectively characterizing the direct signs, such as intimal flap, double lumen, and intramural hematoma (IMH).” (ma2023imaginginvestigationof pages 2-4)
A multicenter STOP-CAD survey shows TCD adoption is variable but common.
Direct quotes: * “Half (29 out of 58) of the sites routinely perform TCD on CAD patients…” (guo2024applicationoftranscranial pages 1-2) * “European institutions show a notably higher rate of TCD application… 76.4% compared to… North America… 34.3% (p = 0.007)” (guo2024applicationoftranscranial pages 3-3)
HITS detection often prompts escalation from antiplatelet to anticoagulation in practice. (guo2024applicationoftranscranial pages 4-4, guo2024applicationoftranscranial pages 5-5)
Not comprehensively addressed in retrieved sources; typical differential in practice includes atherosclerotic stenosis, vasculitis, fibromuscular dysplasia without dissection, and thromboembolic disease without wall hematoma.
A review of emergency medicine literature notes generally favorable outcomes with high proportions achieving functional independence (mRS 0–2) at 3–6 months in historical cohorts, and low mortality (reported ~1.9–5%). (robertson2016cervicalarterydissections pages 6-7)
In a 10-year retrospective cohort (n=62), recurrent ischemic stroke was 4% (2 patients), both within the first 12 months, and estimated 10-year overall survival 71% with 10-year stroke/death-free survival 70%. (lodato2025tenyearoutcomesof pages 5-9)
ESO guideline suggests: * IV alteplase within 4.5 hours for eligible acute ischemic stroke with EAD (weak recommendation, low-quality evidence). (debette2021esoguidelinefor pages 42-43) * Mechanical thrombectomy for anterior-circulation large-vessel occlusion associated with EAD (weak recommendation, very low-quality evidence). (debette2021esoguidelinefor pages 42-43)
These recommendations are summarized in ESO tables (debette2021esoguidelinefor media df12240a, debette2021esoguidelinefor media 106e3d8a).
ESO guideline: in acute symptomatic EAD, clinicians may prescribe either anticoagulants or antiplatelet therapy (strong recommendation; moderate quality). (debette2021esoguidelinefor pages 42-43, debette2021esoguidelinefor pages 37-41)
TREAT-CAD randomized 194 patients to aspirin vs VKA; non-inferiority of aspirin was not demonstrated.
Key outcomes at 3 months (per protocol): primary endpoint 23.1% aspirin vs 14.6% VKA; ischemic stroke 7.7% aspirin vs 0% VKA; major extracranial hemorrhage 0% vs 1.2%; no deaths. (engelter2021aspirinversusanticoagulation pages 7-11)
Direct quote: “non-inferiority of aspirin was not demonstrated.” (engelter2021aspirinversusanticoagulation pages 7-11)
ESO expert consensus (when evidence is low) supports: * DOACs as potential substitutes for VKA in symptomatic EAD patients treated with anticoagulation. (debette2021esoguidelinefor pages 37-41) * Short-term dual antiplatelet therapy (aspirin + clopidogrel) for a few weeks in EAD-related TIA/minor stroke. (debette2021esoguidelinefor pages 37-41)
In the STOP-CAD TCD survey, after HITS detection, some centers switch from SAPT/DAPT to anticoagulation (e.g., 20.7% DAPT→AC; 12.1% SAPT→AC). (guo2024applicationoftranscranial pages 4-4)
(Exact MAXO IDs should be verified against MAXO; provided as best-effort suggestions.)
No evidence-based primary prevention strategy specific to CeAD was captured in the retrieved texts beyond general avoidance of neck trauma in high-risk individuals and control of vascular risk factors.
Immediate initiation of antithrombotic therapy after diagnosis is supported by the observation that ischemic events occur early after CeAD diagnosis. (engelter2021cervicalandintracranial pages 1-2)
No naturally occurring non-human species evidence was identified in the retrieved texts.
The retrieved evidence includes iPSC-derived human smooth muscle cell models used to test vascular-risk loci mechanisms (LRP1 enhancer/KO) rather than animal models.
Model type: in vitro human iPSC-derived smooth muscle cells + CRISPR editing. (liu2024lrp1repressionby pages 1-2)
References
(debette2021esoguidelinefor pages 2-4): Stephanie Debette, Mikael Mazighi, Philippe Bijlenga, Alessandro Pezzini, Masatoshi Koga, Anna Bersano, Janika Kõrv, Julien Haemmerli, Isabella Canavero, Piotr Tekiela, Kaori Miwa, David J Seiffge, Sabrina Schilling, Avtar Lal, Marcel Arnold, Hugh S Markus, Stefan T Engelter, and Jennifer J Majersik. Eso guideline for the management of extracranial and intracranial artery dissection. European Stroke Journal, 6:XXXIX-LXXXVIII, Sep 2021. URL: https://doi.org/10.1177/23969873211046475, doi:10.1177/23969873211046475. This article has 174 citations and is from a peer-reviewed journal.
(debette2021esoguidelinefor pages 1-2): Stephanie Debette, Mikael Mazighi, Philippe Bijlenga, Alessandro Pezzini, Masatoshi Koga, Anna Bersano, Janika Kõrv, Julien Haemmerli, Isabella Canavero, Piotr Tekiela, Kaori Miwa, David J Seiffge, Sabrina Schilling, Avtar Lal, Marcel Arnold, Hugh S Markus, Stefan T Engelter, and Jennifer J Majersik. Eso guideline for the management of extracranial and intracranial artery dissection. European Stroke Journal, 6:XXXIX-LXXXVIII, Sep 2021. URL: https://doi.org/10.1177/23969873211046475, doi:10.1177/23969873211046475. This article has 174 citations and is from a peer-reviewed journal.
(lodato2025tenyearoutcomesof pages 5-9): Marcello Lodato, Rodolfo Pini, Alessandra Porcelli, Enrico Gallitto, Andrea Vacirca, Mauro Gargiulo, and Gianluca Faggioli. Ten-year outcomes of cervical artery dissection: a retrospective study in a real-world cohort. Journal of Clinical Medicine, 14:6836, Sep 2025. URL: https://doi.org/10.3390/jcm14196836, doi:10.3390/jcm14196836. This article has 1 citations.
(engelter2021aspirinversusanticoagulation pages 7-11): Stefan T Engelter, Christopher Traenka, Henrik Gensicke, Sabine A Schaedelin, Andreas R Luft, Barbara Goeggel Simonetti, Urs Fischer, Patrik Michel, Gaia Sirimarco, Georg Kägi, Jochen Vehoff, Krassen Nedeltchev, Timo Kahles, Lars Kellert, Sverre Rosenbaum, Regina von Rennenberg, Roman Sztajzel, Stephen L Leib, Simon Jung, Jan Gralla, Nicole Bruni, David Seiffge, Katharina Feil, Alexandros A Polymeris, Levke Steiner, Janne Hamann, Leo H Bonati, Alex Brehm, Gian Marco De Marchis, Nils Peters, Christoph Stippich, Christian H Nolte, Hanne Christensen, Susanne Wegener, Marios-Nikos Psychogios, Marcel Arnold, Philippe Lyrer, Timo Kahles, Krassen Nedeltchev, Valerian Altersberger, Leo H Bonati, Alex Brehm, Nicole Bruni, Gian Marco De Marchis, Stefan T Engelter, Thomas Fabbro, Urs Fisch, Joachim Fladt, Henrik Gensicke, Lisa Hert, Philippe A Lyrer, Marina Maurer, Nils Peters, Alexandros Polymeris, Marios-Nikos Psychogios, Sabine Schaedelin, Christoph Stippich, Sebastian Thilemann, Christopher Traenka, Benjamin Wagner, Marcel Arnold, Urs Fischer, Barbara Goeggel Simonetti, Jan Gralla, Mirjam Heldner, Simon Jung, Stephen L Leib, David J Seiffge, Hubertus Mueller, Lukas Sveikata, Roman Sztajzel, Hubertus Mueller, Pamela Correia, Ashraf Eskandari, Ivo Meyer, Patrik Michel, Stefania Nannoni, Suzette Remillard, Gaia Sirimarco, Alexandros Zachariadis, Georg Kaegi, Anna Mueller, Jochen Vehoff, Janne Hamann, Andreas R Luft, Levke Steiner, Susanne Wegener, Hebun J Erdur, Christian H Nolte, Regina von Rennenberg, Jan F Scheitz, Katharina Feil, Lars Kellert, Hanne Christensen, and Sverre Rosenbaum. Aspirin versus anticoagulation in cervical artery dissection (treat-cad): an open-label, randomised, non-inferiority trial. The Lancet Neurology, 20:341-350, May 2021. URL: https://doi.org/10.1016/s1474-4422(21)00044-2, doi:10.1016/s1474-4422(21)00044-2. This article has 161 citations and is from a highest quality peer-reviewed journal.
(debette2021esoguidelinefor pages 42-43): Stephanie Debette, Mikael Mazighi, Philippe Bijlenga, Alessandro Pezzini, Masatoshi Koga, Anna Bersano, Janika Kõrv, Julien Haemmerli, Isabella Canavero, Piotr Tekiela, Kaori Miwa, David J Seiffge, Sabrina Schilling, Avtar Lal, Marcel Arnold, Hugh S Markus, Stefan T Engelter, and Jennifer J Majersik. Eso guideline for the management of extracranial and intracranial artery dissection. European Stroke Journal, 6:XXXIX-LXXXVIII, Sep 2021. URL: https://doi.org/10.1177/23969873211046475, doi:10.1177/23969873211046475. This article has 174 citations and is from a peer-reviewed journal.
(debette2021esoguidelinefor pages 37-41): Stephanie Debette, Mikael Mazighi, Philippe Bijlenga, Alessandro Pezzini, Masatoshi Koga, Anna Bersano, Janika Kõrv, Julien Haemmerli, Isabella Canavero, Piotr Tekiela, Kaori Miwa, David J Seiffge, Sabrina Schilling, Avtar Lal, Marcel Arnold, Hugh S Markus, Stefan T Engelter, and Jennifer J Majersik. Eso guideline for the management of extracranial and intracranial artery dissection. European Stroke Journal, 6:XXXIX-LXXXVIII, Sep 2021. URL: https://doi.org/10.1177/23969873211046475, doi:10.1177/23969873211046475. This article has 174 citations and is from a peer-reviewed journal.
(ma2023imaginginvestigationof pages 1-2): Weiqiong Ma, Kexin Zhou, Bowen Lan, Kangyin Chen, Wu-ming Li, and Guihua Jiang. Imaging investigation of cervicocranial artery dissection by using high resolution magnetic resonance vwi and mra: qualitative and quantitative analysis at different stages. BMC Medical Imaging, Nov 2023. URL: https://doi.org/10.1186/s12880-023-01133-z, doi:10.1186/s12880-023-01133-z. This article has 5 citations and is from a peer-reviewed journal.
(ma2023imaginginvestigationof pages 6-9): Weiqiong Ma, Kexin Zhou, Bowen Lan, Kangyin Chen, Wu-ming Li, and Guihua Jiang. Imaging investigation of cervicocranial artery dissection by using high resolution magnetic resonance vwi and mra: qualitative and quantitative analysis at different stages. BMC Medical Imaging, Nov 2023. URL: https://doi.org/10.1186/s12880-023-01133-z, doi:10.1186/s12880-023-01133-z. This article has 5 citations and is from a peer-reviewed journal.
(guo2024applicationoftranscranial pages 1-2): Xiaofan Guo, Behnam Sabayan, Benjamin Shifflett, Muhib Khan, Kateryna Antonenko, Mirjam R. Heldner, Michele Romoli, João Pedro Marto, Zafer Keser, Aaron Rothstein, Ossama Khazaal, Marwa Elnazeir, Harjot Hansra, Brett C. Meyer, Dawn M. Meyer, and Reza Bavarsad Shahripour. Application of transcranial doppler in the diagnosis and management of cervical artery dissection: insights from a multicenter survey within the stop‐cad study. Clinical Neuroimaging, Mar 2024. URL: https://doi.org/10.1002/neo2.70004, doi:10.1002/neo2.70004. This article has 1 citations.
(guo2024applicationoftranscranial pages 4-4): Xiaofan Guo, Behnam Sabayan, Benjamin Shifflett, Muhib Khan, Kateryna Antonenko, Mirjam R. Heldner, Michele Romoli, João Pedro Marto, Zafer Keser, Aaron Rothstein, Ossama Khazaal, Marwa Elnazeir, Harjot Hansra, Brett C. Meyer, Dawn M. Meyer, and Reza Bavarsad Shahripour. Application of transcranial doppler in the diagnosis and management of cervical artery dissection: insights from a multicenter survey within the stop‐cad study. Clinical Neuroimaging, Mar 2024. URL: https://doi.org/10.1002/neo2.70004, doi:10.1002/neo2.70004. This article has 1 citations.
(guo2024applicationoftranscranial pages 3-3): Xiaofan Guo, Behnam Sabayan, Benjamin Shifflett, Muhib Khan, Kateryna Antonenko, Mirjam R. Heldner, Michele Romoli, João Pedro Marto, Zafer Keser, Aaron Rothstein, Ossama Khazaal, Marwa Elnazeir, Harjot Hansra, Brett C. Meyer, Dawn M. Meyer, and Reza Bavarsad Shahripour. Application of transcranial doppler in the diagnosis and management of cervical artery dissection: insights from a multicenter survey within the stop‐cad study. Clinical Neuroimaging, Mar 2024. URL: https://doi.org/10.1002/neo2.70004, doi:10.1002/neo2.70004. This article has 1 citations.
(debette2021esoguidelinefor media df12240a): Stephanie Debette, Mikael Mazighi, Philippe Bijlenga, Alessandro Pezzini, Masatoshi Koga, Anna Bersano, Janika Kõrv, Julien Haemmerli, Isabella Canavero, Piotr Tekiela, Kaori Miwa, David J Seiffge, Sabrina Schilling, Avtar Lal, Marcel Arnold, Hugh S Markus, Stefan T Engelter, and Jennifer J Majersik. Eso guideline for the management of extracranial and intracranial artery dissection. European Stroke Journal, 6:XXXIX-LXXXVIII, Sep 2021. URL: https://doi.org/10.1177/23969873211046475, doi:10.1177/23969873211046475. This article has 174 citations and is from a peer-reviewed journal.
(debette2021esoguidelinefor media 106e3d8a): Stephanie Debette, Mikael Mazighi, Philippe Bijlenga, Alessandro Pezzini, Masatoshi Koga, Anna Bersano, Janika Kõrv, Julien Haemmerli, Isabella Canavero, Piotr Tekiela, Kaori Miwa, David J Seiffge, Sabrina Schilling, Avtar Lal, Marcel Arnold, Hugh S Markus, Stefan T Engelter, and Jennifer J Majersik. Eso guideline for the management of extracranial and intracranial artery dissection. European Stroke Journal, 6:XXXIX-LXXXVIII, Sep 2021. URL: https://doi.org/10.1177/23969873211046475, doi:10.1177/23969873211046475. This article has 174 citations and is from a peer-reviewed journal.
(engelter2021cervicalandintracranial pages 1-2): Stefan T. Engelter, Philippe Lyrer, and Christopher Traenka. Cervical and intracranial artery dissections. Therapeutic Advances in Neurological Disorders, Jan 2021. URL: https://doi.org/10.1177/17562864211037238, doi:10.1177/17562864211037238. This article has 25 citations and is from a peer-reviewed journal.
(filip2023cervicalarterydissections—a pages 1-2): Iulian Roman Filip, Valentin Morosanu, Doina Spinu, Claudiu Motoc, Zoltan Bajko, Emanuela Sarmasan, Corina Roman, and Rodica Balasa. Cervical artery dissections—a demographical analysis of risk factors, clinical characteristics treatment procedures, and outcomes—a single centre study of 54 consecutive cases. Journal of Personalized Medicine, 14:48, Dec 2023. URL: https://doi.org/10.3390/jpm14010048, doi:10.3390/jpm14010048. This article has 5 citations.
(blum2015cervicalarterydissection pages 1-3): Christina A. Blum and Shadi Yaghi. Cervical artery dissection: a review of the epidemiology, pathophysiology, treatment, and outcome. Archives of neuroscience, Oct 2015. URL: https://doi.org/10.5812/archneurosci.26670, doi:10.5812/archneurosci.26670. This article has 214 citations.
(shlapakova2024peripheralbloodgene pages 1-2): Polina S. Shlapakova, Larisa A. Dobrynina, Ludmila A. Kalashnikova, Mariia V. Gubanova, Maria S. Danilova, Elena V. Gnedovskaya, Anastasia P. Grigorenko, Fedor E. Gusev, Andrey D. Manakhov, and Evgeny I. Rogaev. Peripheral blood gene expression profiling reveals molecular pathways associated with cervical artery dissection. International Journal of Molecular Sciences, 25:5205, May 2024. URL: https://doi.org/10.3390/ijms25105205, doi:10.3390/ijms25105205. This article has 4 citations.
(nino2024thenaturalhistory pages 84-88): AC Vargas Nino. The natural history and genetics of cranio-cervical arterial dissections in childhood. Unknown journal, 2024.
(maly2025carotidarterydissection pages 2-4): Petr Malý, Leona Chrastinová, Martin Malý, and Jan M. Horáček. Carotid artery dissection and connective tissue disorders: a review of known gene/protein mutation findings. Military Medical Science Letters, Oct 2025. URL: https://doi.org/10.31482/mmsl.2024.016, doi:10.31482/mmsl.2024.016. This article has 0 citations.
(shlapakova2024peripheralbloodgene pages 2-4): Polina S. Shlapakova, Larisa A. Dobrynina, Ludmila A. Kalashnikova, Mariia V. Gubanova, Maria S. Danilova, Elena V. Gnedovskaya, Anastasia P. Grigorenko, Fedor E. Gusev, Andrey D. Manakhov, and Evgeny I. Rogaev. Peripheral blood gene expression profiling reveals molecular pathways associated with cervical artery dissection. International Journal of Molecular Sciences, 25:5205, May 2024. URL: https://doi.org/10.3390/ijms25105205, doi:10.3390/ijms25105205. This article has 4 citations.
(liu2024lrp1repressionby pages 1-2): Lu Liu, Joséphine Henry, Yingwei Liu, Charlène Jouve, Jean-Sébastien Hulot, Adrien Georges, and Nabila Bouatia-Naji. lrp1 repression by snail results in ecm remodeling in genetic risk for vascular diseases. Circulation Research, 135:1084-1097, Nov 2024. URL: https://doi.org/10.1161/circresaha.124.325269, doi:10.1161/circresaha.124.325269. This article has 13 citations and is from a highest quality peer-reviewed journal.
(liu2024lrp1repressionby pages 11-12): Lu Liu, Joséphine Henry, Yingwei Liu, Charlène Jouve, Jean-Sébastien Hulot, Adrien Georges, and Nabila Bouatia-Naji. lrp1 repression by snail results in ecm remodeling in genetic risk for vascular diseases. Circulation Research, 135:1084-1097, Nov 2024. URL: https://doi.org/10.1161/circresaha.124.325269, doi:10.1161/circresaha.124.325269. This article has 13 citations and is from a highest quality peer-reviewed journal.
(ma2023imaginginvestigationof pages 4-6): Weiqiong Ma, Kexin Zhou, Bowen Lan, Kangyin Chen, Wu-ming Li, and Guihua Jiang. Imaging investigation of cervicocranial artery dissection by using high resolution magnetic resonance vwi and mra: qualitative and quantitative analysis at different stages. BMC Medical Imaging, Nov 2023. URL: https://doi.org/10.1186/s12880-023-01133-z, doi:10.1186/s12880-023-01133-z. This article has 5 citations and is from a peer-reviewed journal.
(ma2023imaginginvestigationof pages 2-4): Weiqiong Ma, Kexin Zhou, Bowen Lan, Kangyin Chen, Wu-ming Li, and Guihua Jiang. Imaging investigation of cervicocranial artery dissection by using high resolution magnetic resonance vwi and mra: qualitative and quantitative analysis at different stages. BMC Medical Imaging, Nov 2023. URL: https://doi.org/10.1186/s12880-023-01133-z, doi:10.1186/s12880-023-01133-z. This article has 5 citations and is from a peer-reviewed journal.
(guo2024applicationoftranscranial pages 5-5): Xiaofan Guo, Behnam Sabayan, Benjamin Shifflett, Muhib Khan, Kateryna Antonenko, Mirjam R. Heldner, Michele Romoli, João Pedro Marto, Zafer Keser, Aaron Rothstein, Ossama Khazaal, Marwa Elnazeir, Harjot Hansra, Brett C. Meyer, Dawn M. Meyer, and Reza Bavarsad Shahripour. Application of transcranial doppler in the diagnosis and management of cervical artery dissection: insights from a multicenter survey within the stop‐cad study. Clinical Neuroimaging, Mar 2024. URL: https://doi.org/10.1002/neo2.70004, doi:10.1002/neo2.70004. This article has 1 citations.
(robertson2016cervicalarterydissections pages 6-7): Jennifer J. Robertson and Alex Koyfman. Cervical artery dissections: a review. The Journal of emergency medicine, 51 5:508-518, Nov 2016. URL: https://doi.org/10.1016/j.jemermed.2015.10.044, doi:10.1016/j.jemermed.2015.10.044. This article has 129 citations.
(engelter2021cervicalandintracranial pages 3-5): Stefan T. Engelter, Philippe Lyrer, and Christopher Traenka. Cervical and intracranial artery dissections. Therapeutic Advances in Neurological Disorders, Jan 2021. URL: https://doi.org/10.1177/17562864211037238, doi:10.1177/17562864211037238. This article has 25 citations and is from a peer-reviewed journal.