脑动脉夹层八例治疗探讨  

A study of the treatment method of cerebral artery dissection

作　　者：尹榕[1] 石向群[1] 张志强[1] 侯雪湄[1] 邵少举[1] 刘雁平[1] 王为民[1] 罗红波[1] 

机构地区：[1]兰州军区兰州总医院神经内科,730050

出　　处：《中华放射学杂志》2012年第7期640-644,共5页Chinese Journal of Radiology

摘　　要：目的探讨脑动脉夹层治疗的方法。方法2009年10月至2011年11月收治经全脑血管造影明确诊断为脑动脉夹层患者8例，给予抗凝、抗血小板治疗，短期内给予复查脑血管造影，若出现血管狭窄进一步加重，则给予介入支架治疗，所有患者治疗后最少经3个月进行复查，根据美国国立卫生研究院卒中量表（NIHSS）评分、改良Rankin量表（mRS）评分和全脑血管造影从影像学和临床神经功能改善状况对治疗效果进行评估。结果8例患者中6例颈动脉夹层，2例椎动脉夹层；入院后给予抗凝治疗4例，抗血小板治疗4例，治疗10-14d后复查造影，其中3例因血管狭窄程度加重或在药物治疗期间出现新发梗死或仍有反复脑缺血发作（TIA），给予支架治疗。经个体化治疗后，随访期内均未出现新发梗死及TIA复发。8例患者NIHSS评分平均值治疗前后分别为5．9、1．6分，mRS评分平均值治疗前后分别为2．5、0．9分。结论针对脑动脉夹层的治疗，介入治疗应个体化，在急性期应给予抗凝或抗血小板药物治疗并短期行脑血管造影，根据临床表现和脑血管造影显示血管狭窄变化，治疗并短期随访，制定下一步治疗方案。Objective To explore the best treatment method of cerebral artery dissection. Methods This study included eight patients who were definitely diagnosed as cerebral artery dissection by the cerebral angiography in our department of neurology during Oct. 2009 and Nov. 2011. They were all treated by the anticoagulation or anti-platelet methods. Some patients received the stent therapy. All patients＇ were followed for at least three months. The treatment effect was assessed by NIHSS, mRS and by the cerebral angiography. Results Six patients had carotid artery dissection, 2 had vertebral artery dissection. Four patients were given anticoagulant therapy and the other 4 were given anti-platelet therapy. The re- examination by angiography 10--14 days after admission showed that in 3 patients, the stenosis was aggravated or the infarction occurred. They were diagnosed as having repeated transient ischemic attack （TIA） during pharmacotherapy and received stents for treatment. There was no TIA and cerebral infarction in the follow-up period after individualized therapy. Mean NIHSS scores of $ patients between pro and post treatment were 5.9, 1.6 respectively. Mean mRS scores pre and post treatment were 2. 5, 0. 9 respectively. Conclusion The treatment for patients with cerebral artery dissection should be individuated. The patients in acute stage should get anticoagulation, anti-platelet therapy and angiography re-examination. According to the clinical manifestation and cerebral angiography, the next step for the treatment should be done.

关 键 词：动脉瘤 夹层 放射学 介入性 支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学]