颈内动脉肌纤维发育不良患者的DSA诊断和治疗  

DSA diagnosis and therapy for fibromuscular dysplasia of the internal carotid artery:a report of 6 cases

作　　者：樊小兵[1] 徐格林[1] 李达文[1] 

机构地区：[1]南京军区南京总医院神经内科,210002

出　　处：《中国脑血管病杂志》2011年第12期645-648,656,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(30870848)

摘　　要：目的探讨颈动脉肌纤维发育不良(FMD)患者的临床特征、诊断及治疗。方法从南京卒中注册系统中检索出2010年5月—2011年5月的6例颈动脉肌纤维发育不良患者,提取这些患者的临床表现、实验室检查和影像学检查、治疗和随访结果等资料。6例FMD患者中1,例合并颈内动脉闭塞,1例合并大脑中动脉闭塞,2例合并夹层动脉瘤。对本组患者的治疗措施有,单纯给予3例患者抗血小板聚集药物治疗;1例患者因合并烟雾病未行抗血小板聚集治疗,只进行对症治疗;2例患者接受颈动脉支架置入及药物治疗。结果①6例FMD患者均经DSA确诊,均有颈内动脉管壁不规则或串珠样改变4,例患者表现为双侧FMD,2例表现为左侧FMD;②给予相应治疗后,6例患者均未出现新发症状,原有症状缓解,2例接受颈内动脉支架置入术的患者,术后均无残余狭窄。③3个月随访均未见缺血事件发生。接受支架置入术的患者,术后6个月复查DSA,支架形态良好,无再狭窄。结论 FMD患者可合并颈内动脉闭塞或颈内动脉夹层动脉瘤。血管内成形术可作为目前有效且安全的治疗方法之一。Objective To retrospectively analyze the clinical data of 6 patients with fibromuscular dysplasia （FMD） of the carotid artery treated in the Department of Neurology, Nanjing General Hospital of Nanjing Military Command. Methods Six patients with FMD of the carotid artery were retrieved from the Nanjing Stroke Registry Program. The data of these patients such as clinical manifestations, laboratory tests, imaging examinations, treatment and follow-up results were collected. Among the FMD patients, 1 complicated with internal carotid occlusion, 1 complicated with middle cerebral artery occlusion, and 2 complicated with dissecting aneurysm. Three patients were treated with anti-platelet aggregation therapy, one patient had not been treated because of complicating with moyamoya disease, and 2 patients were treated with carotid artery stenting. Results ①All the 6 patients with FMD were diagnosed with digital subtraction angiography （DSA） , and they all had irregular internal carotid walls and bead-like changes. Four patients showed bilateral FMD and 2 showed left FMD. ②After appropriate treatment, the 6 patients did not have any new symptoms, and their previous symptoms were relieved. Two patients performed internal carotid artery stenting and there was no residual stenosis after procedure. ③The symptoms of the 6 patients were ameliorated than before after procedure, and no vascular events occurred during the 3-month follow- up. The patients who performed stenting were examined with DSA after 6 months. The shape of the stents was good and no restenosis was found. Conclusion FMD may complicate with internal carotid occlusion or dissecting aneurysm. At present, percutaneous transluminal angioplasty may be one of the safe and effec- tive treatment of this disease.

关 键 词：颈动脉疾病 肌纤维发育不良 血管成形术 

分 类 号：R746[医药卫生—神经病学与精神病学]