颅外段颈内动脉夹层的治疗  

Treatment of extracranial internal carotid artery dissections(report of 4 cases)

作　　者：庄严[1] 邓引生[1] 吴旻[1] 陈泽军[1] 蒋明[1] 焦磊[1] 

机构地区：[1]江苏大学附属医院神经外科,江苏镇江212001

出　　处：《中国临床神经外科杂志》2015年第6期332-334,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颅外段颈内动脉夹层(e ICAD)抗血小板药物治疗及血管内治疗的疗效。方法 2013年6月至2014年12月收治4例e ICAD患者,采用抗血小板药物(阿司匹林100mg/d+氯吡格雷75mg/d)治疗或血管内支架治疗。结果出院后随访6个月,1例在药物治疗2周后出现新发脑缺血事件,给予血管内支架成形术治疗后无再发脑缺血事件;其余3例随访期内未出现新发脑缺血事件。1例血管闭塞的患者,经双抗治疗后,血管再通;2例血管重度狭窄的患者,经双抗治疗后,血管狭窄明显减轻;1例药物治疗无效后血管内支架治疗患者,血管恢复通畅,无残余狭窄。发生脑卒中的3例患者,改良Rankin评分均不同程度的改善。结论对eICAD的治疗,可以选择在阿司匹林联合氯吡格雷抗血小板治疗的基础上,严密观察患者病情,对有新发脑缺血事件的病例,采用血管内支架成形术治疗,可以取得良好的疗效。Objective To explore the effects of antiplatelet and endovascular treatments on extracranial internal carotid artery （ICA） dissections （eICAD）. Methods The clinical data of 4 patients with eICAD, of whom, 3 were treated by antiplatelet therapy and 1 by vascular plasty with stent after the antiplatelet therapy from June, 2013 to December, 2014, were analyzed retrospectively. All the patients were followed up for 6 months. Results No cerebral ischemic event occurred during the following-up in 3 patients treated by antiplateket therapy, of whom, 1 had free ICA which was occluded before the therapy and 2 had slightly narrow ICA which was severely narrow before the therapy. No cerebral ischemic event recurred and ICA narrowed before the therapy became free in 1 patient who were suffered from new cerebral ischemic event two weeks after the antiplatelet therapy and then treated by vascular plasty with stent. No intracranial hemorrhage and peripheral hemorrhage occurred in all the patients. Conclusions Antiplatelet therapy is the basic treatment in the patients with eICAD. Endovascular stenting is a rational choice in the patient who suffers from new cerebral ischemic event during the antiplatelet therapy.

关 键 词：颅外段颈内动脉夹层 脑卒中 抗血小板治疗 支架成形术 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R651.19[医药卫生—临床医学]