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。
Objective To investigate the imaging characteristics, clinical manifestations and treatment methods of cervical artery dissection （CAD）. Methods The CAD patients who were diagnosed by the high resolution magnetic resonance imaging （HR-MRI） or cerebrovascular digital subtraction angiography （.DSA） in the Second Affiliated Hospital of College of Medicine between February 2013 and March 2016 were retrospectively analyzed in this study. Their clinical data were collected and imaging features, clinical symptoms and previous treatments were analyzed. Then they were followed up for 3 months and received imaging examination. Results Fourteen patients were diagnosed by HR-MRI as intramural hematoma, one was diagnosed by DSA as double lumen. Twelve patients had internal carotid artery dissection （lOAD） and mainly exhibited hemiplegia and （or） aphasia- three patients had vertebral artery dissection （VAD） and mainly presented with headache or dizziness. One case underwent percutaneous carotid artery angioplasty, stent implantation, and double-antiplatelet treatment （Aspirin Enteric-coated Tablets 100 mg/d and Clopidogrel Hydrogen Sulphate Tablets 75 mg/d） for 3 months and single-antiplatelet treatment（Aspirin Enteric-coated Tablets 100 mg/d or Clopidogrel Hydrogen Sulphate Tablets 75 mg/d）in the following days. Five cases received single-antiplatelet treatment. Nine patients with severe cervical artery stenosis （〉70%） received double-antiplatelet treatment for 3 months, followed by single- antiplatelet treatment. None suffered from cerebrovascular events or deaths in the three-month follow-up by telephone or outpatient. Neck computer X-ray tomography angiography （CTA） or HR-MRI examination showed that vascular recanalization or stenosis improvement in 7 of the 10 patients who received double-antiplatelet treatment for 3 months. Conclusion HR-MRI and DSA have important diagnostic value for CAD. Antiplatelet drugs are the main treatment for CAD. The effect of interventional therapy rem
出处
《上海医学》
北大核心
2017年第9期552-555,共4页
Shanghai Medical Journal
关键词
颈部动脉夹层
脑卒中
抗栓治疗
血管内治疗
高分辨磁共振成像
Oervical artery dissection
Stroke
Antithrombotic treatment
Endovascular treatment
High resolution magnetic resonance imaging
