创伤性颈内动脉夹层血管内治疗的安全性和有效性分析  

Safety and efficacy of endovascular treatment for traumatic internal carotid artery dissection

作　　者：唐海双 左乔[1] 杨文进[3] 李锦 方亦斌[1] 洪波[1] 许奕[1] 杨鹏飞[1] 黄清海[1] 刘建民[1] TANG Hai-shuang;ZUO Qiao;YANG Wen-jin;LI Jin;FANG Yi-bin;HONG Bo;XU Yi;YANG Peng-fei;HUANG Qing-hai;LIU Jian-min(Stroke Center,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China;Naval Special Medical Center,Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Neurosurgery,People’s Hospital of Pudong New Area,Shanghai 201200,China;Department of Neurosurgery,Affiliated Hospital of Sergeant School,Army Medical University,Shijiazhuang 050000,Hebei,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院脑血管病中心,上海200433 [2]海军军医大学(第二军医大学)海军特色医学中心,上海200433 [3]上海市浦东新区人民医院神经外科,上海201200 [4]陆军军医大学士官学校附属医院神经外科,石家庄050000

出　　处：《第二军医大学学报》2021年第2期140-145,共6页Academic Journal of Second Military Medical University

基　　金：国家重点研发计划(2016YFC1300703);国家自然科学基金(81771264);上海市浦东新区卫生和计划生育委员会特色专病项目(PWZzb2017-09).

摘　　要：目的探讨血管内介入治疗对创伤性颈内动脉夹层(TICAD)的安全性和有效性。方法回顾性纳入2014年1月至2019年11月海军军医大学(第二军医大学)长海医院脑血管病中心收治的经DSA证实为TICAD、采取血管内介入治疗且随访时间≥6个月的16例患者,分析患者一般资料、术后即刻结果、围手术期并发症、临床和影像学随访结果。结果16例TICAD患者中男14例,女2例,年龄为16~63岁,中位年龄为37岁。患者致伤原因包括车祸伤(11例)、拳击伤(1例)、摔伤(1例)、颈部扭伤(1例)、高压水枪伤(1例)、高处坠落伤(1例)。术前影像学检查示14例患者表现为颈内动脉夹层动脉瘤,其中1例患者有2枚夹层动脉瘤。该15枚夹层动脉瘤中5枚接受血流导向装置治疗,8枚接受支架辅助弹簧圈栓塞治疗,1枚接受球囊辅助弹簧圈栓塞治疗,1枚接受单纯支架植入治疗;术后即刻造影见7枚夹层动脉瘤不显影,1枚瘤颈显影,7枚瘤体少量显影。2例患者表现为单纯颈内动脉夹层,均接受单纯支架植入治疗,术后即刻造影均见夹层血管通畅。16例患者均未发生手术相关并发症。16例患者接受临床随访,15例格拉斯哥结局量表评分为5分,1例3分。14例患者接受影像学随访,13例治愈,1例好转。结论血管内治疗对TICAD安全性高,且能有效改善患者临床预后,但该结论尚待大规模前瞻性临床试验证实。Objective To explore the safety and efficacy of endovascular interventional therapy for traumatic internal carotid artery dissection(TICAD).Methods Sixteen patients with TICAD confirmed by digital subtraction angiography(DSA),who received endovascular interventional therapy in the Stroke Center of Changhai Hospital of Naval Medical University(Second Military Medical University)from Jan.2014 to Nov.2019 and followed up for at least 6 months,were retrospectively included.The general characteristics,immediate postoperative outcomes,perioperative complications,and clinical and imaging follow-up data were analyzed.Results There were 14 males and 2 females with a median age of 37 years(range,16-63 years).The causes of TICAD included traffic accident(11 cases),boxing(1 case),falling(1 case),neck sprain(1 case),high-pressure water gunshot(1 case)and high falling(1 case).Preoperative imaging examination showed internal carotid artery dissecting aneurysms in 14 patients,including 1 patient with 2 dissecting aneurysms.Of the 15 dissecting aneurysms,5 were treated with flow diverter,8 with stent-assisted coil embolization,1 with balloon-assisted coil embolization,and 1 with simple stent implantation.Immediate postoperative angiography showed that 7 dissecting aneurysms were completed occluded,1 had residual contrast agent in aneurysm neck,and 7 had residual contrast agent in aneurysm body.Two patients,with imaging examination showing simple internal carotid artery dissection,received simple stent implantation and had resumed blood flow immediately after operation.No operation-related complications developed in the 16 patients.During the clinical follow-up,the Glasgow outcome scale(GOS)score was 5 in 15 patients,and 3 in 1 patient.The follow-up imaging results of 14 patients showed that 13 of them were cured,and 1 was improved.Conclusion Endovascular treatment is safe for TICAD and can effectively improve the clinical prognosis of the patients,but this conclusion needs to be confirmed by large-scale prospective clinical trial

关 键 词：创伤 颈内动脉夹层 血管内治疗 治疗结果 

分 类 号：R654.34[医药卫生—外科学]