Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content + • Primary disease of extracranial arteries other than atherosclerosis is rare ++ Takayasu Arteritis + • Obliterative arteriopathy involving aortic arch vessels• Abdominal aorta and pulmonary arteries can be affected ++ Internal Carotid Dissection + • Originates in internal carotid artery• Acute event that narrows or obliterates lumen• Primary lesion is intimal tear at distal end of carotid bulb• May develop spontaneously ++ Fibromuscular Dysplasia + • Nonatherosclerotic angiopathy, unknown cause affects specific arteries• Usually bilateral disease, involves middle third of internal carotid• Irregular zones of overgrowing media, causing concentric rings• 20% already had stroke at presentation ++ Epidemiology ++ Takayasu Arteritis + • More common in women ++ Internal Carotid Dissection + • Due to trauma or hypertension• Most frequent in young adults ++ Fibromuscular Dysplasia + • Primarily young women affected ++ Symptoms and Signs ++ Internal Carotid Dissection + • Ipsilateral cerebral ischemic symptoms• Acute neck pain, cervical tenderness at the angle of mandible ++ Fibromuscular Dysplasia + • 20% already had stroke ++ Imaging Findings ++ Internal Carotid Dissection + • Duplex US: Indicates narrowing• Arteriography: Characteristic tapered narrowing; if lumen persists, it resumes normal caliber beyond bony foramen ++ Fibromuscular Dysplasia + • Arteriography: Characteristic "string of beads" appearance ++ Rule Out + • Atherosclerotic cerebral disease• Takayasu arteritis• Dissecting aortic aneurysm• Internal carotid dissection• Fibromuscular dysplasia + • Duplex US• Arteriography ++ Takayasu Arteritis + • Corticosteroids and cyclophosphamide are effective• Operative treatment avoided unless active arteritis ++ Internal Carotid Dissection + • Anticoagulation treatment of choice-In most cases, intramural clot is resorbed restoring normal lumen• Operation only for recurrent transient ischemic attacks (TIAs) -If dissection only proximal, replace segment with graft,-If stump pressure > 65 mm Hg, consider proximal ligation-Extracranial-intracranial bypass possible ++ Fibromuscular Dysplasia + • High incidence of neurologic disability-Correct surgically—intraoperative graduated balloon dilation ++ Surgery ++ Indications + • Recurrent TIAs ++ References ++Schievink WI: Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001;344:898. [PubMed: 11259724] GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessSurgery 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessSurgery Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options