How do tortuous blood vessels predispose to cervical artery dissection?

Vascular tortuosity may be associated with cervical artery dissection

Kim BJ, Yang E, Kim NY, et al.

Stroke 2016; 47:2548-2552.



Dissection is an increasingly recognized cause of ischemic stroke, which occurs spontaneously or after trauma, in relatively young patients. We hypothesized that there might be a predisposing factor weakening the vascular wall and that arterial tortuosity might be higher in patients with dissection.


We consecutively enrolled cervical artery dissection (CerAD) patients who had undergone magnetic resonance angiography. Age- and sex-matched healthy subjects who underwent magnetic resonance angiography in a routine health examination were used as controls. The tortuosity was measured semiautomatically from the carotid artery and vertebral artery (VA) arteries. Tortuosity index was defined as: [(arc/chord)−1×100] in each arteries. Independent risk factors associated with CerAD were investigated using multivariable analysis. Subgroup analysis according to the dissected artery was performed.


There were no differences in vascular risk factors between the 75 CerAD patients and the 75 controls. The tortuosity indexes of the contralesional VA (16.3±6.8 versus 12.1±4.5, respectively; P<0.001) and carotid artery (8.8±4.0 versus 7.3±2.9, respectively; P=0.01) were higher in patients with CerAD compared with those of control subjects. VA tortuosity (odds ratio, 1.175; P=0.001) was independently associated with the presence of CerAD. In subgroup analysis, VA tortuosity was significantly higher in 57 patients with VA dissection than in controls (P<0.001), and carotid artery tortuosity was marginally higher in 18 patients with carotid artery dissection (P=0.05).


Cervical artery dissection is associated with tortuous cervical arteries, which may implicate weakened cervical vascular structure in these patients.

This reference is now included in the neurochecklist:

Cervical artery dissection (CAD): causes and risk factors


Abstract link

By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below) Gray's Anatomy, Plate 1210, Public Domain, Link
By Henry Vandyke CarterHenry Gray (1918) Anatomy of the Human Body (See “Book” section below) Gray’s Anatomy, Plate 1210, Public Domain, Link

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