Le dissecazioni dei vasi sopraortici. Presentazione di casistica clinica multicentrica

Spontaneous supraaortic arterial dissection represents a rare pathology; it ranges from 2,6 to 2,9 per 100.000 per year for the carotid arteries and from 1,3 to 1,5 per 100.000 per year for the vertebral arteries. Spontaneous dissection represents the cause of 20 % of the stroke in patients under the age of 30 and 10 % in patients under the age of 40. Etiology include neck trauma, different connective tissue disorders and anomalies of the vascular wall and probably involves a combination of genetic and environmental factors. Typical presentation of spontaneous internal artery dissection is an ipsilateral pain in neck and face with Horner's syndrome and contralateral deficit; lower cranial nerve palsy have been reported in association with dissection. Therapy includes anticoagulation becouse is supported by the demonstration of emboli as the most common cause of stroke in these patients; percutaneous angioplasty and stent deployment may be also indicated. Surgical treatment of dissections, consisting of an interposition graft or extracranial-intracranial bypass, is indicated only for those patients who are not candidates for endovascular treatment. The aim of this review is to present our multicentric clinical experience.