March 01, 2019

A transient ischemic attack caused a tear in my carotid artery. Should it be repaired?

A: My doctor told me I had a transient ischemic attack caused by an internal tear in my carotid artery. So far, I’m only being treated with a drug to prevent blood clotting. Shouldn't the tear be fixed?

Your carotid arteries are among the main vessels that carry blood to your brain. You feel the carotid artery when taking a neck pulse. An artery tear (dissection) occurs when layers of the interior arterial walls separate. With carotid dissection, the dissection rarely goes completely through the artery, due to its elastic outer layers.

But it's still a dangerous situation. Blood in the separated layers of the vessel wall can lead to blood clot formation. A clot can grow, creating an inward bulge that may partially or fully block blood flow of the artery. More commonly, clots can break free of the dissection area and block an artery supplying blood to a portion of the brain. The result is a stroke or a transient ischemic attack (TIA).

A stroke or TIA is common, but doesn't always occur with carotid dissection. Other symptoms include headaches and neck pain — or Horner's syndrome, a condition with an abrupt onset in which one pupil is smaller than the other and the eyelid may droop.

If you have a stroke due to carotid dissection, the first priority is emergency treatment of the stroke or TIA. Aside from that, the main danger of carotid dissection is a stroke — or a second stroke — caused by a blood clot. Thus, a drug to prevent clot formation is typically the go-to treatment for the first three to six months after diagnosis. In many cases, the dissection will seal itself off or heal over time. Follow-up imaging...