A dissected artery is an artery whose wall has torn internally, allowing blood to force its way between the layers of the vessel. This creates a pocket of trapped blood (called a hematoma) inside the artery wall itself, which can narrow or block blood flow. Arterial dissections range from life-threatening emergencies in the aorta to more manageable injuries in the neck arteries, but all require medical attention.
How an Artery Wall Tears Apart
Arteries have three layers. The innermost layer (intima) is a thin lining of cells that keeps blood flowing smoothly. The middle layer (media) is a thick, muscular wall that gives the artery its strength and flexibility. The outer layer (adventitia) is a protective coating.
A dissection happens in one of two ways. In the first, a tear opens in the inner lining, and blood from inside the artery rushes into the middle layer, splitting it apart and creating what’s called a “false lumen,” essentially a second channel within the artery wall. In the second, bleeding starts spontaneously within the middle layer itself, even without a visible tear in the lining. Either way, the pooling blood bulges inward, narrowing the artery and reducing blood flow to whatever organ that artery supplies.
Where Dissections Happen
Dissections can occur in almost any artery, but three locations account for the vast majority of cases.
The Aorta
The aorta is the largest artery in the body, running from the heart down through the chest and abdomen. Aortic dissections are the most dangerous type. They’re classified by location: Type A involves the ascending aorta (the section closest to the heart) and Type B involves the descending aorta (the section running down the back of the chest). This distinction matters enormously because Type A dissections almost always require emergency surgery, while some Type B dissections can be managed with medications alone.
Neck Arteries
The carotid and vertebral arteries carry blood from the neck to the brain. These dissections tend to occur at points where the artery transitions from a flexible, mobile section to one anchored in bone. For the internal carotid artery, the vulnerable spot is where it enters the skull at the base of the ear. For the vertebral artery, it’s the segment near the top of the spine, above and below the first cervical vertebra. The concern with neck artery dissections is stroke: the damaged artery wall can form clots that travel to the brain. About 1.4% of people with traumatic neck artery dissections who don’t initially have a stroke will go on to develop one, with the highest risk concentrated in the first two weeks.
Coronary Arteries
Spontaneous coronary artery dissection (SCAD) affects the arteries supplying the heart muscle and is a recognized cause of heart attacks, particularly in younger people. About 90% of SCAD patients are women, with an average age of 52. Men who develop SCAD tend to be slightly younger, averaging around 49.
Causes and Risk Factors
Some dissections result from obvious trauma, like a car accident, a sports injury, or even vigorous chiropractic manipulation of the neck. Others happen spontaneously, with no clear trigger.
Connective tissue disorders significantly raise the risk. Conditions like vascular Ehlers-Danlos syndrome (which affects roughly 1 in 50,000 to 200,000 people) weaken the structural proteins in artery walls, making them prone to tearing. Fibromuscular dysplasia, a condition that causes abnormal cell growth in artery walls, is another major risk factor and is closely associated with both cervical dissections and SCAD. Arteries that are unusually curved or tortuous are also more vulnerable.
High blood pressure is the most common modifiable risk factor for aortic dissections. Other contributors include smoking, cocaine use, and intense physical exertion. For SCAD specifically, emotional stress can serve as a trigger, particularly in women.
Symptoms by Location
The symptoms depend entirely on which artery is affected.
Aortic dissections typically cause sudden, severe chest or upper back pain often described as tearing or ripping. The pain can radiate to the neck, stomach, or legs. Some people develop stroke-like symptoms, leg pain, or difficulty walking as blood flow to various organs is compromised. This is a 911-level emergency.
Carotid artery dissections in the neck most commonly cause pain around the temple (46% of cases) or forehead (19%), often on one side. Vertebral artery dissections cause pain in the back of the head and neck in about 80% of cases. Either type can produce stroke symptoms: sudden weakness on one side of the body, vision changes, trouble speaking, or severe dizziness.
SCAD presents like a heart attack, with chest pain, shortness of breath, and sometimes nausea or sweating.
How Dissections Are Diagnosed
CT angiography (a CT scan with contrast dye highlighting the blood vessels) is the primary imaging tool. For vertebral artery dissections, CT angiography has been shown to detect 100% of cases when compared against traditional catheter-based angiography, outperforming MRI-based imaging (77% sensitivity) and ultrasound (71%). For aortic dissections, CT angiography is fast enough to guide emergency treatment decisions, which matters when minutes count.
MRI with specialized vessel imaging is sometimes used as a follow-up tool, particularly for neck artery dissections, because it can directly visualize the blood trapped within the artery wall.
Treatment Approaches
Treatment varies dramatically based on where the dissection is and how severe it is.
Type A aortic dissections are surgical emergencies. Without surgery, the mortality rate is staggering: roughly 47% of patients die within the first 24 hours, rising to 55% by 48 hours and nearly 84% within a year. The hourly death rate during the first day is about 2.6%. Surgery involves replacing the damaged section of the aorta.
Type B aortic dissections are often managed initially with aggressive blood pressure control. The immediate goal is to bring systolic blood pressure down to 100 to 120 mmHg and heart rate below 60 beats per minute, reducing the force of blood against the damaged artery wall. Surgery or stent placement may be needed if complications develop, such as organ damage from reduced blood flow.
Neck artery dissections are typically treated with blood thinners to prevent clots from forming at the injury site and traveling to the brain. Most heal on their own over weeks to months. Recurrence is rare unless an underlying connective tissue disorder is present.
SCAD treatment depends on whether blood flow to the heart is critically compromised. Many cases heal without intervention, though some require stenting or other procedures.
Recovery and Physical Activity
After the acute phase, most people with arterial dissections can return to regular physical activity, but with some adjustments. For general cardiovascular fitness, guidelines recommend working toward 30 to 40 minutes of moderate-intensity exercise five to seven days a week, matching recommendations for the general population.
Resistance training is encouraged but with important modifications: using lighter weights with more repetitions, focusing on proper breathing technique, and avoiding straining or holding your breath during lifts. Observed safe upper limits have been around 9 kg (about 20 pounds) for women and 23 kg (about 50 pounds) for men, though many patients find these limits overly conservative, and there’s no evidence that heavier loads with proper technique are harmful.
People recovering from carotid or vertebral artery dissections should avoid resistance training, including bodyweight exercises like push-ups and sit-ups, for the first 8 to 12 weeks after the event. After that window, the same general guidelines apply. Across all types of dissection, the consistent advice is to avoid abrupt high-intensity bursts, extreme competitive or contact sports, exercising to exhaustion, and training in extreme heat or cold.