In Reply

We completely agree with our correspondents that the etiology of dissections of the cervical arteries is an important question that has so far not been satisfactory answered. In our article about the clinical features of dissection of the cervical arteries we mentioned this only in passing (1). The importance of genetic factors in addition to those that are already known, such as Ehlers-Danlos syndrome, is the subject of scientific studies (2). Differentiating between aortic dissection and dissection of the cervical arteries—which are different clinical entities/disorders—is of the utmost importance (1). Loeys-Dietz syndrome, as mentioned by Prof. Schmidtke and Prof. von Kodolitsch, in many cases causes aortic dissection, but only very rarely dissection in other vessels, and isolated dissection of the carotid artery without involvement of the aortic root was not observed by Loeys and Dietz for their syndrome (3). For this reason we do not think that investigation for Loeys-Dietz syndrome is promising in dissection of the cervical arteries. We therefore recommend comprehensive genetic diagnostic evaluation not for every spontaneous (and thus etiologically unclear) dissection of the cervical arteries but only where familial clustering is observed (2, 4).