頸動脈盜血綜合征的臨床及影像特點分析
發(fā)布時間：2018-10-13 07:09
【摘要】：[目的]1、有關(guān)頸動脈盜血綜合征的臨床報道較少,病例類型單一,臨床表現(xiàn)復(fù)雜多變,臨床癥狀與血管病變不相符,診斷率低。分析頸動脈盜血綜合征的臨床及影像學特點,為其臨床診斷提供參考。2、分析頸動脈盜血綜合征的側(cè)支循環(huán)建立與代償方式評估頸動脈盜血綜合征患者的預(yù)后。3、頸動脈內(nèi)膜剝除術(shù)及頸動脈支架植入術(shù)是治療頸動脈盜血綜合征患者的兩種主要治療方法,通過分析兩種治療方法,評估頸動脈盜血綜合征患者的循環(huán)改善程度,為治療提供依據(jù)。[方法]1、搜集2016年3月～2017年3月在昆明醫(yī)科大學第二附屬醫(yī)院住院治療的頸動脈盜血綜合征患者11例。2、收集所有研究對象的臨床資料,包括病史采集及危險因素分析,如性別、年齡、吸煙、飲酒、高血壓病、糖尿病、高脂血癥、高同型半胱氨酸血癥、腦卒中史等。于入院第二天晨起空腹取靜脈血,測定空腹血糖、血脂、同型半胱氨酸、肝腎功能等。3、住院期間對11例患者均進行頸部血管彩超或經(jīng)顱多普勒、頭顱CTA或MRA、數(shù)字減影血管造影等檢查。4、在證實為頸動脈盜血綜合征后,其中9例患者在住院期間行頸動脈內(nèi)膜剝除術(shù)或頸動脈內(nèi)支架植入術(shù),2例僅藥物保守治療。5、對11例患者進行出院后3個月、6個月和1年時間的隨訪。隨訪內(nèi)容包括:(1).mRs量表評估;(2).是否發(fā)生缺血性腦血管事件;(3).卒中二級預(yù)防藥物服用情況;(4).血管危險因素管理情況。[結(jié)果]1、共納入11例頸動脈盜血綜合征患者,其中男性7例(63.6%),女性4例(36.4%),年齡57-79歲,平均年齡(62.5±4.2)歲,均存在腦血管病相關(guān)危險因素:吸煙史6例(54.5%),飲酒史2例(18.2%),高血壓9例(81.8%),糖尿病3例(27.3%),高脂血癥8例(72.7%),高同型半胱氨酸血癥10例(90.9%),腦卒中病史3例(27.3%)。2、11例受試者中,頸內(nèi)動脈閉塞2例(18.2%),頸內(nèi)動脈重度狹窄9例(81.8%)。單側(cè)頸內(nèi)動脈病變7例(63.6%),其中1例為閉塞,6例為重度狹窄(其中1例因夾層導(dǎo)致);雙側(cè)頸內(nèi)動脈病變4例(36.4%)(其中1例為雙側(cè)閉塞,其他3例為一側(cè)重度狹窄、一側(cè)中度狹窄)。3、頸動脈盜血綜合征的主要臨床表現(xiàn)為分水嶺梗死或短暫性腦缺血發(fā)作。本病例中,后循環(huán)短暫性腦缺血發(fā)作5例(45.5%),后循環(huán)腦梗死2例(18.2%),前循環(huán)短暫性腦缺血發(fā)作2例(18.2%),前循環(huán)腦梗死2例(18.2%);數(shù)字減影血管造影顯示:發(fā)生病變的頸內(nèi)動脈和頸總動脈共18支,13支累及頸內(nèi)動脈起始段;11例受檢者均有側(cè)支循環(huán)建立,一級側(cè)支循環(huán)11例(100%),二級側(cè)支循環(huán)4例(36.4%),三級側(cè)支循環(huán)1例(9.1%);ASITN評分0-2級的1例(9.1%),3級的4例(36.4%),4級的6例(54.5%);前交通動脈開放4例(36.4%),后交通動脈開放6例(54.5%),前后交通動脈同時開放1例(9.1%)。4、11例患者均在危險因素管理的基礎(chǔ)上進行藥物治療,其中9例重度狹窄患者行手術(shù)治療,5例行頸動脈支架植入術(shù),4例行頸動脈內(nèi)膜剝除術(shù),2例閉塞患者僅給予藥物保守治療。所有患者均在出院后3個月、6個月、1年時間進行隨訪,2例行頸動脈支架植入術(shù)的患者出院后不同時期出現(xiàn)卒中樣癥狀,其中1例因自行停服抗血小板聚集、他汀類藥物治療,1個月后出現(xiàn)反復(fù)前循環(huán)短暫性腦缺血發(fā)作;1例在常規(guī)用藥的前提下,出院后6個月仍出現(xiàn)卒中樣癥狀。4例行頸動脈內(nèi)膜剝除術(shù)的患者,術(shù)后1年進行隨訪,均未發(fā)生卒中。2例頸動脈閉塞患者出院后仍有間斷頭暈發(fā)作,多次復(fù)查頭顱MRI提示:多發(fā)腔隙性腦梗塞。[結(jié)論]1、頸動脈盜血綜合征患者的頸內(nèi)動脈病變多位于顱外段,臨床上多表現(xiàn)為前、后循環(huán)短暫性腦缺血發(fā)作或分水嶺梗死,臨床表現(xiàn)與病變血管不一致。由于頸動脈的嚴重狹窄或閉塞,側(cè)支循環(huán)的代償起著重要作用,數(shù)字減影血管造影是其確診方法;2、低灌注可能是頸動脈盜血綜合征的發(fā)病機制,頸動脈支架植入術(shù)或頸動脈內(nèi)膜剝除術(shù)是目前頸動脈盜血綜合征的有效治療手段;短期內(nèi)頸動脈盜血綜合征患者行頸動脈支架植入術(shù)與頸動脈內(nèi)膜剝除術(shù)預(yù)后均較好,而遠期效果頸動脈內(nèi)膜剝除術(shù)可能優(yōu)于頸動脈支架植入術(shù);3、對于頸動脈閉塞的頸動脈盜血綜合征患者,藥物保守治療效果欠佳,血管再通術(shù)能否成為頸內(nèi)動脈閉塞的最佳治療方案,仍需進一步研究。
[Abstract]:[Objective] 1. There are fewer clinical reports about carotid artery steal syndrome, the case type is single, the clinical manifestation is changeable, the clinical symptoms are not consistent with the vascular disease, and the diagnosis rate is low. To analyze the clinical and imaging characteristics of carotid artery steal syndrome and provide reference for its clinical diagnosis. Carotid endarterectomy and carotid artery stent implantation are two main treatment methods for patients with carotid artery steal syndrome.[Methods] 1. Collect 11 cases of carotid artery steal syndrome hospitalized in the Second Affiliated Hospital of Kunming Medical University from March 2016 to March 2017. 2. Collect clinical data of all subjects, including medical history collection and risk factors analysis, such as sex, age, smoking, drinking, Hypertension, diabetes, hyperlipidemia, hyperhomocysteinemia, history of stroke, etc. fasting blood glucose, blood lipid, homocysteine and liver and kidney function were measured on the morning after admission to the hospital. In the hospitalization period, 11 patients were examined with color Doppler ultrasound or cranial Doppler, cranial CTA or MRA, digital subtraction angiography and so on. Nine patients underwent carotid endarterectomy or carotid endoluminal stent implantation during hospitalization and 2 were only conservative. 5. Follow-up of 3 months, 6 months and 1 year after discharge was performed in 11 patients. Follow-up includes: (1). mRS scale assessment; (2). Whether ischemic cerebrovascular events have occurred; (3). Secondary prevention of stroke in stroke; (4). Management of vascular risk factors.[Results] Among 11 patients with carotid artery steal syndrome, 7 of them (63.6%), 4 women (36. 4%), aged 57-79 years, mean age (65.2. 5, 4.2), were associated with cerebrovascular diseases: 6 cases (54. 5%) of smoking history. There were 2 cases (18. 2%) of drinking history, 9 cases of hypertension (81.8%), 3 cases of diabetes (27. 3%), 8 cases of hyperlipidemia (72.7%), 10 cases of hyperhomocysteinemia (90.9%), 3 cases of cerebral stroke (27. 3%). Among 11 subjects, 2 cases (18.2%) were occluded by internal carotid artery. There were 9 cases of severe stenosis of internal carotid artery (81.8%). There were 7 cases (63.6%) of unilateral internal carotid artery disease, of which 1 case was occlusion, 6 cases were severe stenosis (1 case was caused by dissection); 4 cases (36. 4%) of double-sided internal carotid artery disease (1 case was double-sided occlusion, 3 others were severe stenosis on one side, one side was moderately narrow). 3, The main clinical manifestations of carotid steal syndrome are watershed infarction or transient ischemic attack. In this case, 5 cases (44.5%) of transient ischemic attack, 2 cases (18.2%) of post-circulating cerebral infarction, 2 cases of transient ischemic attack (18.2%), 2 cases of anterior circulation cerebral infarction (18.2%), 2 cases of anterior circulation cerebral infarction (18.2%), and digital subtraction angiography showed that: There were 18 branches of internal carotid artery and total carotid artery, 13 of which involved the initial segment of internal carotid artery; 11 subjects had side branch circulation, 11 cases (100%) of primary side branch, 4 cases (36. 4%) of secondary side branch and 1 case (97.1%) of tertiary side branch. One case (97.1%) of ASITN score of 0-2, 4 cases (36. 4%) of grade 3, 6 cases (54. 5%) of grade 4, 4 cases (34.4%) of open traffic artery, 6 cases (54. 5%) open posterior communicating artery, 1 case (92.1%) open at the same time of anterior and posterior communicating artery, all of 11 patients were treated with drugs on the basis of risk factor management. Among them, 9 patients with severe stenosis underwent surgical treatment, 5 cases of carotid artery stent implantation, 4 cases of carotid endarterectomy, 2 patients with occlusive disease only given the conservative treatment. All patients were followed up for 3 months, 6 months, 1 year after discharge, 2 patients with carotid artery stent implantation developed stroke-like symptoms at different times of discharge, of which 1 case had anti-platelet aggregation due to self-stop. Statins were treated for 1 month post-recurrent transient ischemic attack; 1 had stroke-like symptoms in 6 months after discharge on the basis of conventional medication. 4 patients with carotid endarterectomy were followed up for 1 year, No stroke occurred in 2 cases of carotid artery occlusion. 2 cases of carotid artery occlusion still had intermittent giddiness and multiple reexamination of cranial MRI revealed: multiple lacunar cerebral infarction.[Conclusion] 1. The internal carotid artery lesions of the patients with carotid artery steal syndrome are located in the extracranial segment, and the clinical manifestations are anterior and posterior circulation transient ischemic attack or watershed infarction, and the clinical manifestations are inconsistent with the diseased vessels. due to the severe stenosis or occlusion of the carotid artery, the compensation of collateral circulation plays an important role, and the digital subtraction angiography is a definite diagnosis method; 2, the low perfusion may be the pathogenesis of the carotid steal syndrome, Carotid stent implantation or carotid endarterectomy is an effective method for the treatment of carotid artery steal syndrome at present. The prognosis of carotid artery stent implantation and carotid endarterectomy is better in the short term. But long-term effect carotid endarterectomy may be superior to carotid artery stent implantation; 3. For patients with carotid artery occlusion with carotid artery occlusion, the conservative treatment effect of drugs is poor, and vascular restenosis can become the best treatment plan for internal carotid artery occlusion, and further study is still needed.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
本文編號：2267735
[Abstract]:[Objective] 1. There are fewer clinical reports about carotid artery steal syndrome, the case type is single, the clinical manifestation is changeable, the clinical symptoms are not consistent with the vascular disease, and the diagnosis rate is low. To analyze the clinical and imaging characteristics of carotid artery steal syndrome and provide reference for its clinical diagnosis. Carotid endarterectomy and carotid artery stent implantation are two main treatment methods for patients with carotid artery steal syndrome.[Methods] 1. Collect 11 cases of carotid artery steal syndrome hospitalized in the Second Affiliated Hospital of Kunming Medical University from March 2016 to March 2017. 2. Collect clinical data of all subjects, including medical history collection and risk factors analysis, such as sex, age, smoking, drinking, Hypertension, diabetes, hyperlipidemia, hyperhomocysteinemia, history of stroke, etc. fasting blood glucose, blood lipid, homocysteine and liver and kidney function were measured on the morning after admission to the hospital. In the hospitalization period, 11 patients were examined with color Doppler ultrasound or cranial Doppler, cranial CTA or MRA, digital subtraction angiography and so on. Nine patients underwent carotid endarterectomy or carotid endoluminal stent implantation during hospitalization and 2 were only conservative. 5. Follow-up of 3 months, 6 months and 1 year after discharge was performed in 11 patients. Follow-up includes: (1). mRS scale assessment; (2). Whether ischemic cerebrovascular events have occurred; (3). Secondary prevention of stroke in stroke; (4). Management of vascular risk factors.[Results] Among 11 patients with carotid artery steal syndrome, 7 of them (63.6%), 4 women (36. 4%), aged 57-79 years, mean age (65.2. 5, 4.2), were associated with cerebrovascular diseases: 6 cases (54. 5%) of smoking history. There were 2 cases (18. 2%) of drinking history, 9 cases of hypertension (81.8%), 3 cases of diabetes (27. 3%), 8 cases of hyperlipidemia (72.7%), 10 cases of hyperhomocysteinemia (90.9%), 3 cases of cerebral stroke (27. 3%). Among 11 subjects, 2 cases (18.2%) were occluded by internal carotid artery. There were 9 cases of severe stenosis of internal carotid artery (81.8%). There were 7 cases (63.6%) of unilateral internal carotid artery disease, of which 1 case was occlusion, 6 cases were severe stenosis (1 case was caused by dissection); 4 cases (36. 4%) of double-sided internal carotid artery disease (1 case was double-sided occlusion, 3 others were severe stenosis on one side, one side was moderately narrow). 3, The main clinical manifestations of carotid steal syndrome are watershed infarction or transient ischemic attack. In this case, 5 cases (44.5%) of transient ischemic attack, 2 cases (18.2%) of post-circulating cerebral infarction, 2 cases of transient ischemic attack (18.2%), 2 cases of anterior circulation cerebral infarction (18.2%), 2 cases of anterior circulation cerebral infarction (18.2%), and digital subtraction angiography showed that: There were 18 branches of internal carotid artery and total carotid artery, 13 of which involved the initial segment of internal carotid artery; 11 subjects had side branch circulation, 11 cases (100%) of primary side branch, 4 cases (36. 4%) of secondary side branch and 1 case (97.1%) of tertiary side branch. One case (97.1%) of ASITN score of 0-2, 4 cases (36. 4%) of grade 3, 6 cases (54. 5%) of grade 4, 4 cases (34.4%) of open traffic artery, 6 cases (54. 5%) open posterior communicating artery, 1 case (92.1%) open at the same time of anterior and posterior communicating artery, all of 11 patients were treated with drugs on the basis of risk factor management. Among them, 9 patients with severe stenosis underwent surgical treatment, 5 cases of carotid artery stent implantation, 4 cases of carotid endarterectomy, 2 patients with occlusive disease only given the conservative treatment. All patients were followed up for 3 months, 6 months, 1 year after discharge, 2 patients with carotid artery stent implantation developed stroke-like symptoms at different times of discharge, of which 1 case had anti-platelet aggregation due to self-stop. Statins were treated for 1 month post-recurrent transient ischemic attack; 1 had stroke-like symptoms in 6 months after discharge on the basis of conventional medication. 4 patients with carotid endarterectomy were followed up for 1 year, No stroke occurred in 2 cases of carotid artery occlusion. 2 cases of carotid artery occlusion still had intermittent giddiness and multiple reexamination of cranial MRI revealed: multiple lacunar cerebral infarction.[Conclusion] 1. The internal carotid artery lesions of the patients with carotid artery steal syndrome are located in the extracranial segment, and the clinical manifestations are anterior and posterior circulation transient ischemic attack or watershed infarction, and the clinical manifestations are inconsistent with the diseased vessels. due to the severe stenosis or occlusion of the carotid artery, the compensation of collateral circulation plays an important role, and the digital subtraction angiography is a definite diagnosis method; 2, the low perfusion may be the pathogenesis of the carotid steal syndrome, Carotid stent implantation or carotid endarterectomy is an effective method for the treatment of carotid artery steal syndrome at present. The prognosis of carotid artery stent implantation and carotid endarterectomy is better in the short term. But long-term effect carotid endarterectomy may be superior to carotid artery stent implantation; 3. For patients with carotid artery occlusion with carotid artery occlusion, the conservative treatment effect of drugs is poor, and vascular restenosis can become the best treatment plan for internal carotid artery occlusion, and further study is still needed.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
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