Dissection of the internal carotid artery after chiropractic manipulation of the neck

Peters, Mallory; Böhl, Jürgen; Thömke, Frank; Kallen, K-J.; Mahlzahn, K.; Wandel, E; Büschenfelde, K-H Meyer zum

doi:10.1212/wnl.45.12.2284

Cited by 101 publications

(52 citation statements)

References 1 publication

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“…The treatment of extracranial carotid artery dissection with anticoagulation has been proved to be effective, with an approximate 50%-70% arterial recanalization rate and a 10% risk of late neurologic deficits (32)(33)(34)(35)(36)(37)(38)(39). However, the high incidence of stroke within 30 days of the dissection (21%-41%) and the approximately 20% mortality rate make a compelling argument for alternative, more successful treatment strategies for overcoming these medical impasses (37).…”

Section: Discussionmentioning

confidence: 99%

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Donas¹,

Mayer²,

Guber³

et al. 2008

Journal of Vascular and Interventional Radiology

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PURPOSE: To provide evidence for the endovascular repair of patients with extracranial carotid artery dissection. MATERIALS AND METHODS: A comprehensive literature review was performed whereby all studies that reported on the results of endoluminal repair of extracranial carotid artery dissection and provided information about primary technical and clinical success were identified. The Pubmed, Embase, and Medline databases were searched between January 1997 and February 2008 by two independent observers by using combinations of search terms "endovascular repair," "extracranial carotid artery," and "carotid dissection." RESULTS: After studies were selected according to the given criteria, 13 studies were included in our statistical analysis. The number of reported patients was 62, with a total of 63 extracranial carotid artery dissections. The mean patient age was 43.3 years. The mean follow-up period was 15.7 months +/-8.7. Various causes were responsible for the disease, including a blunt neck injury in 28 patients (45%), spontaneous dissection in 21 (37%), and iatrogenic trauma during invasive radiologic procedure in 17.7% patients. The technical success rate was 100% (63 of 63 procedures). The primary and 1-year patency rate of the stents and/or stent-grafts was 100%. The overall major adverse cardiovascular events rate was 11% (seven strokes). The total follow-up mortality rate was 0%. CONCLUSIONS: The current status of the reported cases in the literature regarding the treatment of carotid artery dissection by means of stent placement shows excellent early and 1-year patency rates and a low major adverse cardiovascular event rate. However, further evaluation is necessary to draw robust conclusions.

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Section: Discussionmentioning

confidence: 99%

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Donas¹,

Mayer²,

Guber³

et al. 2008

Journal of Vascular and Interventional Radiology

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“…50 The final patient was noted to have a red flag symptom of vertigo prior to receiving CSM. 75 In these cases, it appears that the clinician may have missed or ignored symptoms indicating that the patient was at risk for serious injury. Although evidence for VBI testing and related symptoms to rule out the presence of CAD are lacking, it is unwise for clinicians to disregard these symptoms and continue to perform CSM in their presence.…”

Section: 112mentioning

confidence: 99%

Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports

Puentedura

March

Anders

et al. 2012

Journal of Manual & Manipulative Therapy

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Background: Cervical spine manipulation (CSM) is a commonly utilized intervention, but its use remains controversial.Purpose: To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AEs) after receiving CSM to determine if the CSM was used appropriately, and if these types of AEs could have been prevented using sound clinical reasoning on the part of the clinician. Data sources: PubMed and the Cumulative Index to Nursing and Allied Health were systematically searched for case reports between 1950 and 2010 of AEs following CSM. Study selection: Case reports were included if they were peer-reviewed; published between 1950 and 2010; case reports or case series; and had CSM as an intervention. Articles were excluded if the AE occurred without CSM (e.g. spontaneous); they were systematic or literature reviews. Data extracted from each case report included: gender; age; who performed the CSM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the CSM; and type of resultant AE. Data synthesis: Based on the information gathered, CSMs were categorized as appropriate or inappropriate, and AEs were categorized as preventable, unpreventable, or unknown. Chi-square analysis with an alpha level of 0.05 was used to determine if there was a difference in proportion between six categories: appropriate/preventable, appropriate/unpreventable, appropriate/unknown, inappropriate/ preventable, inappropriate/unpreventable, and inappropriate/unknown. Results: One hundred thirty four cases, reported in 93 case reports, were reviewed. There was no significant difference in proportions between appropriateness and preventability, P5.46. Of the 134 cases, 60 (44.8%) were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%) were categorized as 'unknown'. CSM was performed appropriately in 80.6% of cases. Death resulted in 5.2% (n57) of the cases, mostly caused by arterial dissection. Limitations: There may have been discrepancies between what was reported in the cases and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the CSM, published many of the cases. Conclusions: This review showed that, if all contraindications and red flags were ruled out, there was potential for a clinician to prevent 44.8% of AEs associated with CSM. Additionally, 10.4% of the events were unpreventable, suggesting some inherent risk associated with CSM even after a thorough exam and proper clinical reasoning.

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“…Most dissections involve minor trauma, stretch, or mechanical stress. Chiropractic manipulation can also cause CAD [4]. The etiology of spontaneous dissection is thought to be multifactorial.…”

Section: Discussionmentioning

confidence: 99%

Carotid artery dissection caused by Eagle syndrome

Choi

Song

et al. 2017

Precis Future Med

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Cervical artery dissection is caused by the separation of the vessel wall layers following either a tear in the intima or rupture of the vasa vasorum, with bleeding within the media, and is a potential source of thromboembolism, resulting in cerebral ischemia. Cervical artery dissection can be traumatic or spontaneous; however, the exact pathophysiology of a dissection is rarely identified. We report a case of carotid artery dissection caused by stylocarotid artery syndrome (Eagle syndrome), treated by surgical resection of the styloid process.

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Dissection of the internal carotid artery after chiropractic manipulation of the neck

Cited by 101 publications

References 1 publication

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports

Carotid artery dissection caused by Eagle syndrome

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