Investigation of extracranial internal carotid and vertebral artery dissection after cervical spine manipulation

Objective: Cervical artery dissection (CAD) is considered one of these complications in the treatment of cervical spine manipulation (CSM), which can lead to severe complications such as stroke or death. This study aimed to explore the common manifestations and probable mechanisms of CAD caused by CSM according to the imaging findings. Methods: We retrospectively analyzed the clinical and imaging data of all patients diagnosed with CAD in the PACs system during the past 2 years in our hospital. All patients with cervical massage-induced CAD were included in this study. The imaging data was analyzed to determine the location and extent of the dissection and whether there were intracranial complications. Results: A total of 7 patients and 8 dissected vessels participated in the final cohort study, including 4 internal carotid artery dissections (ICADs) and 4 vertebral artery dissections (VADs). All patients had corresponding stroke manifestations. Through imaging analysis of each patient, we found that the C1 segment of the internal carotid artery was involved in all patients with ICAD and the V3 segment of the vertebral artery dissection was involved in all patients with VAD. Conclusions: The C1 segment of the internal carotid artery and the V3 segment of the vertebral artery may be the sites most frequently involved in CAD caused by CSM, and more evidence is needed to support the results of this study in the future.