10例脑动脉夹层患者的影像学特点及治疗分析  

Analysis on Imaging Features and Treatment of 10 Patients with Cerebral Artery Dissection

作　　者：贾颐 代晓杰[1] 董素娟[1] 樊同 刘建军[1] 

机构地区：[1]西安高新医院神经内科,陕西省西安市710075

出　　处：《实用心脑肺血管病杂志》2015年第9期90-92,共3页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家临床重点专科建设项目经费资助(201105)

摘　　要：目的分析10例脑动脉夹层（CAD）患者的影像学特点及治疗情况。方法收集西安高新医院神经内科2006年6月—2013年1月收治10例CAD患者的临床资料,回顾性分析其一般资料、影像学检查结果、治疗结果及预后情况。结果 10例患者中男6例,女4例;年龄15~62岁;有高血压病史者3例,吸烟史者5例,均无糖尿病家族史;自发性脑动脉夹层6例,创伤性脑动脉夹层4例（2例为脑血管介入治疗引起的并发症,2例为运动后创伤）;6例为颈动脉夹层,2例为大脑中动脉夹层,1例为椎动脉夹层,1例为大脑后动脉夹层。首次数字减影血管造影（DSA）检查结果显示：血管闭塞6例,其中左颈内动脉（LICA）C1段闭塞3例,左大脑中动脉（LMCA）M1段闭塞1例,右颈内动脉（RICA）C6段闭塞1例,右椎动脉（RVA）V1段闭塞1例;重度线样狭窄2例,其中右大脑中动脉（RMCA）M1远端狭窄1例,左大脑后动脉（LPCA）P2段狭窄1例;局部血管分层狭窄2例,其中LICA C1段分层狭窄1例,LICA C2段内膜分层狭窄1例。经抗血小板聚集、抗凝、支架植入等治疗后,所有患者病变血管全部再通,血管形态均恢复正常。随访2年,磁共振血管造影（MRA）示所有患者血管形态稳定,未出现再发卒中或短暂性脑缺血发作。结论 DSA检查结果显示双腔征和内瓣膜是CAD的特征性表现。目前对于抗凝治疗或是抗血小板聚集治疗仍存在争议,抗栓治疗仍是CAD确诊后的首选方案,治疗后需动态随访并及时复查DSA,血管内支架治疗可作为药物治疗的补充。Objective To analyze the imaging features and treatment of 10 patients with cerebral artery dissection.Methods Clinical data of 10 cerebral artery dissection patients admitted to the Department of Neurology,Gaoxin Hospital of Xi＇an from June 2006 to January 2013 was collected,and general information,imaging findings,treatment outcome and prognosis were retrospectively analyzed. Results Of the 10 patients,6 cases were male,4 cases were female,aged at 15 to 62 years old,3 cases had positive hypertension history,5 cases had positive smoking history, but no one of them had positive family diabetic history; 6 cases were spontaneous,4 cases were traumatic（ 2 cases caused by cerebrovascular intervention- induced complications,2 cases caused by post- exercise trauma）; 6 cases classified as caritid artery dissection,2 cases as middle cerebral artery dissection,1 case as vertebral artery dissection,1 case as posterior cerebral artery dissection. The first DSA examination results showed that： 6 cases were with vessel occlusion（ including 3 cases with occlusion of left internal carotid artery C1,1 case with occlusion of left main coronary artery M1,1 case with occlusion of right internal carotid artery C6,1 case with occlusion of right vertebral artery V1）,2 cases with severe line- like stenosis（ including 1 case with distal stenosis of right middle cerebral artery M1,1 case with stenosis of left posterior cerebral artery P2）,2 cases with local vessel hierarchical stenosis（ including 1 case with hierarchical stenosis of left internal carotid artery C1,1 case with intima hierarchical stenosis of left internal carotid artery C2）. After treatment of anti- platelet aggregation,anticoagulation and stent implantation,all of the patients＇ affected vessels recanalizated, the shape returned to normal. After 2 years of fellow- up, MRA examination results showed that,all of the patients＇ vessel shape was stable, no one occurred recurrence of stroke or transient ischemic attack.Conclusion Double cavity sign and i

关 键 词：脑动脉疾病 磁共振成像 介入性 抗凝药 

分 类 号：R364.15[医药卫生—病理学]