Arterial Dissection | Diagnosis & Treatment

How is arterial dissection diagnosed?

Treatment for arterial dissection depends on the location of the blood vessel tear and the extent of the damage. To determine these, physicians use a number of imaging tests to get detailed images of your child's blood vessels and brain tissue. Tests can include:

  • CT angiography (CTA), which uses x-ray equipment and powerful computers to create cross-sectional images (often called "slices") of the head, neck and brain. CTA uses a special dye (known as contrast) that is injected into a vein. A computer generates detailed 3D images of the blood vessels.
  • Magnetic resonance angiography (MRA), which visualizes blood vessels in the brain, head and neck, but without the need for x-rays. Unlike CTA, many MRA scans can be done without injecting a dye into the veins to generate images of the vessels.
  • Catheter angiography, which is done under general anesthesia. A catheter (a flexible tube about the width of spaghetti) is placed directly into the child's arteries. The catheter is used to inject a special dye, known as contrast, allowing us to get more detailed images.

The treatment team will provide advance instructions on how to prepare for these tests. In addition to the above imaging tests, neurologists may conduct a variety of specific tests to assess your child's brain function.

How is arterial dissection treated?

Treatment of arterial dissection is tailored to each child depending on the location of the blood vessel tear and its severity.

Dissection in the head and neck

If the dissection is in blood vessels in the neck rather than the head (known as extracranial dissection) and is relatively small, physicians in the Stroke and Cerebrovascular Center usually place children on anticoagulant (blood-thinning) drugs for at least three to six months. This decreases the chance of a clot forming and then flowing into the brain. They will use imaging tests to make sure that the vessel has healed before stopping the medication.

If the vessel tear is too severe to heal on its own, there are two options: Your child's physician can place a stent (a thin, flexible metal mesh tube) inside the artery to create a new, stable inside surface, or they can close the injured artery to prevent it from becoming a source of clots that might flow into the brain. If an artery is to be closed, they will perform extensive testing (known as balloon test occlusion) beforehand to ensure that there will be enough blood supply from neighboring bridging arteries.

Dissection in the brain

When the dissection is in vessels within your child's brain, the artery is usually too injured to remain viable. In this case, the child is at greater risk for a brain hemorrhage than for a blood clot. Treatment is usually aimed at closing the torn vessels before they cause bleeding, which can be done either surgically or through catheter-based endovascular techniques.

If healthy nearby arteries cannot supply enough blood in place of the dissected arteries, a direct arterial bypass may be necessary as a first step. The most common form of this operation is known as a superficial temporal to middle cerebral artery anastomosis or STA-MCA bypass, in which neurosurgeons join a blood vessel from your child's scalp directly to a vessel in the brain to improve blood flow.