Cervical artery dissections: evidence for redissection in previously dissected arteries: report of three cases.

Abstract

Among patients with spontaneous internal carotid artery (ICA) or vertebral artery dissections, there is a small but significant risk of development of dissection in an uninvolved ICA or vertebral artery at some time in the future. Recurrence of dissection in a previously dissected and healed ICA or vertebral artery is very rare. We retrospectively reviewed more than 400 cases of cervical artery dissections in our cerebrovascular records for 1970 through 2000. Three patients with recurrence of dissection in previously dissected and presumably healed ICAs were identified. All three patients were women. Their ages at the time of the initial dissection were 42, 38, and 31 years. Initial ICA dissections were bilateral in all cases, occurring simultaneously in one case and 1 year apart in the other two cases. All dissections were spontaneous. Redissection of a previously dissected and healed ICA in these three patents occurred 11, 6, and 12 years later, respectively. Two patients had fibromuscular dysplasia. Our experience with these three cases, from among more than 400 cases of cervical artery dissections treated at our institution, and the very limited number of reported cases in the literature indicate the rarity of recurrence of dissection in previously dissected and healed cervical arteries. An underlying arteriopathy may be suspected in many of these cases. Management requires medical and sometimes surgical approaches.