Understanding Carotid Artery Dissections
Nine years ago, I experienced a medical rarity, and I’ve spent the time since focused on sharing my experience in the hopes of raising awareness about a condition that few people really understand.
Unlike a bone break or other easily diagnosed condition, I experienced a carotid artery dissection (CAD), which can cause an array of symptoms that aren’t unique to this condition, such as headaches, neck pain, facial pain, vision changes and ringing in the ears. On the more severe side, CADs can cause stroke symptoms including face drooping, dizziness, numbness and difficulty speaking.
Because CADs are rare and can present themselves in many ways, diagnosis is challenging. This has a direct impact on care, which is why there is such a need for increased awareness about them.
What is a CAD?
Simply put, a CAD is a tear within the wall lining of a carotid artery. The human body has two carotid arteries: one on each side of the neck. Their purpose is to supply oxygenated blood to the brain. When a CAD occurs, the tear lets blood get in between the layers of the wall lining and separates them. This causes the lining to bulge, constricting—even preventing—blood flow. The bulging can also affect other areas if it presses on nearby structures and nerves.
Tears in artery walls can also trigger the body’s clotting system. Clots can block blood flow at the site of the tear, or they can break free and block blood flow elsewhere in the body. Whether by dissection or clot, decreased or impeded blood flow can have severe health implications. When carotid artery blood flow is restricted, the brain receives less oxygen than it needs, which can cause an array of complications, including stroke, transient ischemic attack (sometimes referred to as a mini stroke) and cerebral aneurysm.
Types of CAD
There are two types of CADs:
Spontaneous dissections happen without apparent trauma. In many cases, it isn’t possible to determine their cause. Underlying conditions, however, such as connective tissue disorders, high blood pressure and fibromuscular dysplasia can weaken artery walls, increasing their susceptibility to dissection.
Trauma can also cause dissections. Car accidents and sports injury are common culprits, but even neck manipulation during chiropractic treatment can be risky. That’s because the rapid stretching or twisting of the neck can cause a tear in the artery's inner lining.
My dissection was spontaneous, but I do have family members who have experienced dissections as well. Family history can put you at higher risk of having a CAD. My dad had two, but I had forgotten about that when my symptoms set in.
CAD symptoms and diagnosis
The degree of reduced blood flow to the brain is what causes the range of possible complications. For example, my CAD caused a 90% blockage, which is why I experienced severe headaches and ultimately lost my ability to speak clearly—one of the more common symptoms of stroke. Other symptoms may be more prominent in cases where blood flow is less restricted, such as headaches and tinnitus (ringing in the ears). The risk here is that these symptoms are less commonly associated with stroke, which increases the possibility of misdiagnosis.
In my case, I experienced a severe headache and ear pain for several days after I lost my
speech. During that period, I was misdiagnosed twice: once with a migraine and once with an ear infection. This is a primary reason why we need more awareness. The longer the brain doesn’t have enough oxygen, the more at risk a person is of long-term health complications—and death.
To accurately diagnose a CAD, health practitioners need to be able to see the carotid arteries. Imaging tools (e.g., ultrasound, CT scan, MRI) are good first steps. The most accurate method, however, involves the injection of contrast die into the bloodstream to make blood vessels easier to see.
Once diagnosed, CADs can be treated in several ways, typically determined by severity. The most critical aspect of treatment is restoring proper blood flow. When arteries are narrowed or impeded by clots, blood thinning is a typical first step. In addition to easing blood flood, anticoagulants can help prevent clots and reduce the risk of stroke.
In more severe cases, particularly when the risk of stroke is high, surgery may be needed. There are two surgical options. When possible, doctors may opt to place a stent at the location of the dissection to keep arteries open. These procedures are minimally invasive. In more severe situations, surgeons may seek to repair torn arteries or remove affected sections.
My situation involved a 90% blockage, which might typically require one of the two surgical options. Fortunately, my body benefits from an atypically strong Circle of Willis, which is a ring of vessels that connect the front and back circulations of the brain. This amplified source of circulation helped cover the shortcomings of a 90% blockage in my left carotid artery.
There were discussions about using a stent to treat my dissection, but my team of doctors determined that there was more risk associated with surgery than there was with treating me with anticoagulants.
While I am thankful that I did not need surgery, my dissection will never fully heal. Reduced from 90%, my artery remains constricted by about 50%. My doctors told me to expect any healing to occur within the first three months. They said I shouldn’t expect much additional improvement after that period.
Who is at risk of CAD?
The risk of CAD is low, but everyone is at risk. Three in 100,000 people will have a CAD in their lifetime, but it’s not something that just happens at specific ages or to specific demographics. CADs actually tend to occur more in younger adults than older adults. They’re also a common cause of stroke in people under 50. And according to the CDC, stroke is the fifth leading cause of death in the U.S.
I was just 41 when I had my dissection.
Carotid artery dissection is complex and very dangerous. It’s nowhere near as studied or talked about as it should be, especially when you consider how easy it is to misdiagnose. I consider myself lucky to be alive. In addition to being misdiagnosed, I brushed off symptoms that were telling me something was wrong. I know that urgent care isn’t the place to get a complex medical diagnosis, but I let 10 days pass after slurring my speech before I saw a neurologist.
You know your body better than anyone. If something doesn’t seem right, put yourself in charge of getting to the bottom of it—no matter what.
To learn more about carotid artery dissection and my story visit: www.mystrokeofhope.com.