Internal carotid and vertebral artery dissection: morphology, pathophysiology and provoking factors

Kalashnikova LA, Gulevskaya TS, Sakharova AV, Chaykovskaya RP, Gubanova MV, Danilova MS, Shabalina AA, Dobrynina LA
About authors

Research Center of Neurology, Moscow, Russia

Correspondence should be addressed: Ludmila A. Kalashnikova
Volokolamskoe shosse, 80, Moscow, 125367; ur.xednay@ncnavokinhsalak

About paper

Funding: this study was part of the state assignment for Research Center of Neurology.

Author contribution: Kalashnikova LA, Gubanova MV — literature analysis, data acquisition, processing of the obtained data, manuscript preparation; Gulveskaya TS, Sakharova AV, Chaykovskaya RP, Shabalina AA — data acquisition, analysis and interpretation; Danilova MS — recruitment of participants; Dobrynina LA — processing of the obtained data, manuscript preparation.

Received: 2019-09-03 Accepted: 2019-10-19 Published online: 2019-10-04

The causes of internal carotid artery (ICA) and vertebral artery (VA) dissection, as well as its provoking factors, remain understudied. The aim of this paper was to explore morphological changes in the ICA/VA walls, factors provoking dissection, clinical signs and biomarkers of connective tissue (CT) damage. A total of 271 patients were examined, of whom 54% were women. The mean age of the participants was 37.0 ± 10 years. Clinical signs and biomarkers of CT damage (matrix metalloproteinase 9, tissue inhibitor of metalloproteinase 1, hydroxyproline, sulphated glycosaminoglycans) were analyzed in 82 patients and 40 healthy volunteers. Histologic examination of dissected and seemingly intact arteries conducted in 5 cases revealed signs of arterial wall dysplasia similar to those characteristics of fibromuscular dysplasia: thinning and splitting of the internal elastic membrane, areas of fibrosis, irregular orientation of myocytes, and their necrosis in the tunica media. Clinical signs and biomarkers of CT dysplasia (CTD) were more pronounced in patients with arterial dissection than in the controls. The major provoking factors were head turns and physical activity (42%), minor head injury (10%), and acute respiratory infection in the month preceding arterial dissection (14%). We conclude that arterial wall dysplasia is a predisposing factor for ICA/VA dissection, both spontaneous and provoked. The analysis of CTD biomarkers and clinical signs suggests connective tissue pathology in patients with ICA/VA dissection.

Keywords: internal carotid artery dissection, vertebral artery dissection, morphological changes in the arterial wall, clinical signs of connective tissue dysplasia, biomarkers of connective tissue damage, factors provoking dissection