Arterial Dissection in Antiphospholipid Syndrome Patients: Two Case Reports and a Literature Review

Abstract

Antiphospholipid syndrome (APS) is a multisystemic autoimmune disease which presents with thromboembolic disease, pregnancy complications and the presence of antiphospholipid antibodies. There are some reports of arterial dissections in different sites of the body associated with APS. We describe two patients with APS who developed ischaemic stroke as a result of vertebral artery dissection in the absence of acquired and genetic risk factors for arterial dissection. We also conducted a systematic review of the literature for cases of arterial dissection associated with APS. We suspect that APS may be a potential cause of vasculopathy and arterial dissection. Further research is needed to explore this possible association.

Antiphospholipid syndrome, antiphospholipid antibodies, and stroke

“…Thrombosis is thought to be the most common mechanism, with intracranial large arteries, particularly the middle cerebral artery (MCA), being the most common site of occlusion. 10 Embolism from valvular heart disease (Libman–Sacks endocarditis), extracranial carotid artery lesions, 11 vasculitis-like manifestations, 12 chronic occlusive vasculopathy affecting small- and medium-sized intracerebral arteries, 13 and carotid or vertebral artery dissection 14 are also described.…”

Acute Tongue Swelling as a Still Unexpected Manifestation of Internal Carotid Artery Dissection: A Case Report

“…Internal carotid artery dissection is strongly associated with trauma [ 19 , 20 , 21 ], but it also occurs without any tangible connection with any trauma [ 14 , 22 , 23 , 24 ]. The haematoma dissecting the arterial wall penetrates between the middle and the inner membrane causing the inner membrane to bulge into the lumen of the artery.…”

“…The CT-angiography (CTA) of the aorta and renal arteries did not reveal any evidence of fibromuscular dysplasia. No data were found for this disease in the image of the cerebral arteries [ 13 , 14 , 15 , 16 ]. In addition, there were no radiological features of Eagle syndrome [ 17 ] based on the CTA of the neck ( Figure 4 ).…”

A warning before the storm: Spontaneous dissection of coronary artery and abdominal aorta in a patient with recurrent miscarriages

“…in 21 cases associated with APS, including five cases involving the coronary artery, five with the vertebral artery, four in the aorta, three in the carotid artery, three in the cerebral artery, and one in the femoral artery. 2 All of the previous case reports described a single arterial dissection complicating the course of APS. In contrast, our patient developed multiple dissections within a span of 2 weeks as part of a probable CAPS episode.…”

“…of the carotid or vertebral arteries resulting in cerebral infarction. 2 However, arterial dissection has not been described in the context of catastrophic APS (CAPS), despite the fact that patients with CAPS should be at substantial risk for vascular injury and dissection due to the high intensity of inflammation typically observed in CAPS. Here, we describe a female patient with a history of recurrent miscarriage who presented with spontaneous dissection of the coronary artery and abdominal aorta, as well as multiorgan thrombosis.…”