Arch Vessel Dissection

Supra-aortic vessel dissections are a common cause of stroke especially in young and middle-aged patients. Dissections may occur spontaneously or traumatically. A tear in the vessel wall may lead to intramural hematoma and intimal flap formation, potentially compromising normal blood flow. Possible complications include pseudoaneurysm formation, thrombosis at the injured vessel site, and distal emboli to cerebral arteries. Arterial dissections may be classified according to Borgess and Biffl classifications depending on the lesion etiology, flow alteration, and severity of vessel wall involvement. The majority of dissections are managed conservatively using anticoagulants and antiplatelet medication. Endovascular treatment options are usually reserved for patients with acute/recurring neurological deficits and simultaneous intracranial vessel occlusions.