Multivessel cervicocephalic and visceral arterial dissections: Pathogenic role of primary arterial disease in cervicocephalic arterial dissections.

The origin and pathogenesis of spontaneous internal carotid artery dissections in most cases remain unclear. It is presumed that in many cases an underlying arterial disease may predispose the artery to the mural dissection. In about 15% of cases, there is angiographic evidence of fibromuscular dysplasia in carotid, vertebral, or renal arteries. Uncommonly, cases of cystic medial necrosis and, rarely, other arterial diseases have been reported. However, in the majority of cases, no arterial disease can be documented. Multivessel spontaneous dissections strongly suggest the presence of underlying arterial disease despite absence of any angiographic or laboratory findings pointing to any specific arteriopathy. In this communication, three cases of multivessel cervicocephalic and visceral arterial dissections are reported. Angiographic and laboratory data gave no clues to the nature of the underlying arterial disease. Further clinical observations and histopathologic studies, when possible, as well as biochemical studies should provide more insight into the origin and pathogenesis of the spontaneous arterial dissections.