Artery dissection, arterial

Diseases. Liquid crystals have been impHcated in a number of disease conditions in the human body. A complex cholesterol—phosphoHpid—Hpoprotein Hquid crystal phase has been identified in the initiation and maintenance of atheromatous deposits on the aortic intima in dissected human and rabbit arteries (40). The paracrystalHne nature of this precursor to plaque buildup with the resultant loss of arterial elasticity... 

Ischemic stroke has numerous causes. Cerebral infarction may result from large artery atherosclerosis, cardiac embolism, small artery lipohyalinosis, cryptogenic embolism, or, more rarely, from other diverse conditions such as arterial dissection, infective endocarditis, and sickle cell disease. Arterial occlusion is the cause of at least 80% of acute cerebral infarctions. " ... 

Based primarily on the study protocol of the 1995 NINDS rt-PA study.Many centers would also exclude patients with known documented endocarditis or aortic dissection, and those with CT hypoattenuation in more than one third of the middle cerebral artery territory. There are insufficient data to support the use of rt-PA for ischemic stroke in pregnancy or in the pediatric population (age <18 years). 

IV rt-PA has been safely given in patients with cervical arterial dissection There are four reports of IV rt-PA use in pregnancy, with one case complicated by intrauterine hematoma,rt-PA should be used in this setting only after careful assessment of the risks and benefits. There is insufficient data to determine the benefit of rt-PA in the pediatric population, with no randomized trials. 

Findlay JM, Ashforth R, Dean N. Malignant carotid artery dissection. Can J Neurol Sci 2002 29 378-385. 

Dissection of the internal carotid and vertebral arteries is a common cause of stroke, particularly in young patients. Although many occur due to trauma, it is estimated that over half occur spontaneously. The mechanism of stroke following arterial dissection is either by artery-to-artery embolism, by thrombosis in situ, or by dissection-induced lumenal stenosis with secondary cerebral hypoperfusion and low-flow watershed infarction. Occasionally, dissection may lead to the formation of a pseudoaneurysm as a source of thrombus formation. Vertebrobasilar dissections that extend intracranially have a higher risk of rupture leading to subarachnoid hemorrhage (SAH). ° ... 

Acute anticoagulation is widely used in the acute setting of arterial dissection. Once again, the rationale is to prevent propagation of local thrombosis and formation of new thrombus at the site of the injured arterial wall, which is beheved to reduce the likelihood of early stroke recurrence. This practice, while rational, is based on anecdotal evidence and case series, as randomized controlled trials have... 

Full-dose heparin may be used when there are selected indications, such as cardiac sources with a high risk of recurrent embohsm, arterial dissection, or high-grade arterial stenosis prior to surgery (Level of Evidence IV). 

Bassi P, Lattuada R Gomitoni A. Cervical cerebral artery dissection a multicenter prospective study (preliminary report). Neurol Sci 2003 24 (Suppl.l) S4—S7. 

Lucas C, Moulin T, Deplanque D, Tatu L, Chavot D. Stroke patterns of internal carotid artery dissection in 40 patients. Stroke 1998 29 2646-2648. 

Han DH, Kwon OK, Oh CW. Clinical characteristics of vertebrobasilar artery dissection. Neurol Med Chir Tokyo) 1998 38(SuppL) 107-113. 

Jacobs A, Lanfermann H, Neveling M, Szelies B, Schroder R, Heiss WD. MRI- and MRA-guided therapy of carotid and vertebral artery dissections. J Neurol Sci 1997 147 27-34. 

Engelter S, Lyrer P, Kirsch E, Steck AJ. Long-term follow-up after extracranial internal carotid artery dissection. Eur Neurol 2000 44 199-204. 

Schievink W. The treatment of spontaneous carotid and vertebral artery dissections. Curr Opin Cardiol 2000 15 316-321. 

Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Cochrane... 

Beletsky V, Nadareishvili Z, Lynch J, Shuaib A, Woolfenden A, Norris JW, for the Canadian Stroke Consortium. Cervical arterial dissection time for a therapeutic trial Stroke 2003 34 2856-2860. 

Malek AM, Higashida RT, Phatouros CC, Lempert TE, Meyers PM, Smith WS, Dowd CP, Halbach VV. Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty. AJNR Am J Neuroradiol 2000 21 ... 

Cardiac Aortic dissection, coronary artery vasospasm, pericarditis, valvular heart disease... 

We carefully dissected rat tail arteries and loaded them with a Ca2+ indicator, Fluo-3. After a rectangular glass capillary was inserted into the lumen of the excised arteries, [Ca2+] in smooth muscle cells within the arterial wall was visualized using a confocal microscope. Brief electrical shocks were delivered at 5 Hz to the preparations to stimulate the sympathetic nerve network present in the adventitia. We found Ca2+ signals with diverse spatiotemporal patterns, Ca2+ waves and oscillations in individual smooth muscle cells during the sympathetic nerve stimulation (lino et al 1994). 

Cardiovascular- Subacute bacterial endocarditis arterial sclerosis dissecting... 

Possible complications include massive myocardial infarction due to retrograde flow around the occlusion balloon, complete heart block, ventricular fibrillation, stroke, dissection of the left anterior descending artery, and right coronary artery thrombosis. Though high grade atrioventricular blockage occurs relatively frequently, procedural mortality rate is low (0-4%) and severe complications are rare and often avoidable (7-10). 

A profound complication of septal ablation is anterior Ml due to ethanol reflux from the septal perforator down the left anterior descending artery. This can be avoided by careful position of the balloon and angiographic monitoring. Other rare complications include coronary dissection, perforation, thrombosis, and spasm. 

Spontaneous dissection of the internal carotid or the vertebral artery is an important cause of ischemic stroke in young adults (Fig. 1.3). In the late 1970s Fisher et al. (1978) and Mokri et al. (1979) described dissections of carotid and vertebral arteries as detected by modern diagnostic techniques rather than by post-mortem examination. This may occur... 

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