本文選題：頸部動脈夾層 + 腦卒中　； 參考：《上海醫(yī)學(xué)》2017年09期

【摘要】：目的探討頸部動脈夾層(CAD)的影像學(xué)特征、臨床表現(xiàn)和治療方法。方法回顧性分析2013年2月—2016年3月就診于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院,并經(jīng)高分辨磁共振成像(HR-MRI)或腦血管數(shù)字減影血管造影(DSA)檢查確診的CAD患者15例,收集所有患者的臨床資料,分析患者治療前的影像學(xué)特征、臨床癥狀和治療方法。隨訪3個月,并進行影像學(xué)復(fù)查。結(jié)果 15例CAD患者中,通過HR-MRI檢查顯示壁內(nèi)血腫確診14例,通過DSA檢查顯示雙腔征確診1例。頸內(nèi)動脈夾層(ICAD)12例,主要表現(xiàn)為偏癱和(或)言語障礙等;椎動脈夾層(VAD)3例,僅以頭痛或頭暈為主要表現(xiàn)。15例CAD患者中,1例行經(jīng)皮頸內(nèi)動脈球囊擴張術(shù)+支架植入術(shù),并給予雙抗治療(阿司匹林腸溶片100mg/d+硫酸氫氯吡格雷片75 mg/d)3個月,后改為單抗治療(阿司匹林腸溶片100mg/d或硫酸氫氯吡格雷片75mg/d);余14例患者均給予抗血小板聚集治療,其中5例給予單抗治療,9例伴管腔重度狹窄(狹窄70%)的患者給予雙抗治療3個月后改為單抗治療。在治療3個月時進行電話或門診隨訪,15例CAD患者中均無新發(fā)的腦血管事件或死亡;10例行雙抗治療的患者中,7例在治療3個月時復(fù)查頸部計算機X射線斷層掃描血管造影(CTA)或HR-MRI檢查,提示血管再通或狹窄改善。結(jié)論 HR-MRI和DSA檢查對CAD具有重要的診斷價值,抗血小板聚集治療是CAD的主要治療方案,介入治療的療效尚需進一步隨訪觀察。
[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.
【作者單位】： 浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院神經(jīng)內(nèi)科;浙江省嘉興市第一醫(yī)院康復(fù)科;
【分類號】：R543.4

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