颈部动脉夹层15例临床分析

发布时间：2018-05-27 11:32

本文选题：颈部动脉夹层 + 脑卒中　；参考：《上海医学》2017年09期

【摘要】：目的探讨颈部动脉夹层(CAD)的影像学特征、临床表现和治疗方法。方法回顾性分析2013年2月—2016年3月就诊于浙江大学医学院附属第二医院,并经高分辨磁共振成像(HR-MRI)或脑血管数字减影血管造影(DSA)检查确诊的CAD患者15例,收集所有患者的临床资料,分析患者治疗前的影像学特征、临床症状和治疗方法。随访3个月,并进行影像学复查。结果 15例CAD患者中,通过HR-MRI检查显示壁内血肿确诊14例,通过DSA检查显示双腔征确诊1例。颈内动脉夹层(ICAD)12例,主要表现为偏瘫和(或)言语障碍等;椎动脉夹层(VAD)3例,仅以头痛或头晕为主要表现。15例CAD患者中,1例行经皮颈内动脉球囊扩张术+支架植入术,并给予双抗治疗(阿司匹林肠溶片100mg/d+硫酸氢氯吡格雷片75 mg/d)3个月,后改为单抗治疗(阿司匹林肠溶片100mg/d或硫酸氢氯吡格雷片75mg/d);余14例患者均给予抗血小板聚集治疗,其中5例给予单抗治疗,9例伴管腔重度狭窄(狭窄70%)的患者给予双抗治疗3个月后改为单抗治疗。在治疗3个月时进行电话或门诊随访,15例CAD患者中均无新发的脑血管事件或死亡;10例行双抗治疗的患者中,7例在治疗3个月时复查颈部计算机X射线断层扫描血管造影(CTA)或HR-MRI检查,提示血管再通或狭窄改善。结论 HR-MRI和DSA检查对CAD具有重要的诊断价值,抗血小板聚集治疗是CAD的主要治疗方案,介入治疗的疗效尚需进一步随访观察。
[Abstract]:Objective to investigate the imaging features, clinical manifestations and treatment of cervical artery dissection (CAD). Methods from February 2013 to March 2016, 15 patients with CAD who were admitted to the second affiliated Hospital of Zhejiang University Medical College and diagnosed by HR-MRI (high resolution magnetic resonance imaging) or digital subtraction angiography (DSA) were retrospectively analyzed. The clinical data of all patients were collected and the imaging features, clinical symptoms and treatment methods were analyzed before treatment. Follow-up 3 months, and imaging review. Results among the 15 cases of CAD, 14 cases were diagnosed by HR-MRI and 1 case by DSA. There were 12 cases of internal carotid artery dissection with hemiplegia and / or speech disorder, 3 cases of vertebral artery dissection with VADD, and 1 case with percutaneous balloon dilatation of internal carotid artery with stenting, only with headache or dizziness as the main manifestation. They were treated with double antibody (aspirin enteric-coated tablet 100mg/d hydroclopidogrel 75 mg / d) for 3 months and then treated with monoclonal antibody (aspirin enteric tablet 100mg/d or hydroclopidogrel sulfate 75 mg / d). The remaining 14 patients were treated with anti-platelet aggregation therapy. Among them, 5 cases were treated with monoclonal antibody, 9 cases with severe stenosis of lumen (70% stenosis) were treated with double antibody for 3 months and then treated with monoclonal antibody. All 15 CAD patients were followed up by telephone or outpatient for 3 months. No new cerebrovascular events or death occurred. 7 out of 10 patients who received double antibody therapy were re-examined at 3 months after treatment with computed tomography of the neck. Tube angiography (CTA) or HR-MRI, The results suggest that the recanalization or stenosis of blood vessels can be improved. Conclusion HR-MRI and DSA are important in the diagnosis of CAD. Antiplatelet aggregation therapy is the main therapeutic regimen for CAD. The effect of interventional therapy should be further followed up.
【作者单位】：浙江大学医学院附属第二医院神经内科;浙江省嘉兴市第一医院康复科;
【分类号】：R543.4

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