颈动脉蹼相关脑梗死的临床特征与血管重建治疗(附3例报告及文献复习)  

Clinical Features and Revascularization Therapy of Cerebral Infarction Associated with Cartotid Webs

作　　者：王子高 茅翼亭 赵鸿琛 凌倚峰 曹文杰 WANG Zi-Gao;MAO Yi-ting;ZHAO Hong-chen;LING Yi-feng;CAO Wen-jie(Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院神经科,上海200040

出　　处：《中国临床神经科学》2021年第3期280-288,共9页Chinese Journal of Clinical Neurosciences

摘　　要：目的探讨颈动脉蹼相关脑梗死的临床特征及血管重建治疗疗效。方法回顾性分析3例颈动脉蹼相关脑梗死且接受血管重建治疗病例的临床资料,总结颈动脉蹼相关脑梗死的临床表现、神经影像学特点及血管重建治疗疗效。结果3例患者中,男性2例、女性1例,脑卒中发病平均年龄53岁。均以急性前循环脑梗死起病,平均NIHSS评分为10分,梗死灶分布符合栓塞性特点。3例患者DSA造影共发现颈动脉蹼3枚,椎动脉蹼1枚。3枚颈动脉蹼突向管腔的平均长度为2.7 mm,致颈内动脉平均狭窄率为43%,与颈内动脉后壁的平均夹角为67.1°,在蹼远端均存在造影剂淤滞。2例患者接受颈动脉支架植入术,1例患者接受颈内动脉剥脱术,手术成功率100%,围手术期并发症率为0。平均随访17个月,脑卒中复发率为0。结论颈动脉蹼远端存在血液淤滞,可引起动脉至动脉栓塞性脑梗死,颈动脉血管重建治疗可有效降低颈动脉蹼相关脑卒中的复发风险。Aim To investigate the clinical features and effects of revascularization therapy in ischemic stroke associated with carotid webs.Methods The clinical data of three patients suffering from cerebral infarction associated with carotid webs were analyzed retrospectively.The clinical characteristics,the neuroimaging findings,and the effects of revascularization therapy were reviewed.Results Two male and one female patients suffering from cerebral infarction associated with carotid webs were collected in this study.All the three patients presented with acute anterior circulation artery-to-artery embolism at a median age of 53 years old,with a median NIHSS score of 10 at onset.Three carotid webs and one vertebral web were found by cerebral digital subtraction angiography.The three carotid webs had a median protrusion length of 2.7 mm resulting in a mean of forty-three percents of stenosis of the lumen,and had a median intersection angle of 67.1 degree between the web and posterior wall of the carotid artery.Contrast stagnation was found in the distal surfaces of all the three carotid webs.Two patients underwent carotid angioplasty and stenting and one received carotid endarterectomy.All the surgeries were successfully performed with no periprocedural complications.No recurrent strokes occurred in a median follow-up of 17 months.Conclusion Blood stagnation distal to the carotid web results in an artery to artery cerebral embolism.Carotid revascularization can efficiently prevent the recurrent strokes in patients with carotid webs.

关 键 词：颈动脉蹼 脑梗死 血管重建 颈动脉支架植入术 颈动脉内膜剥脱术 

分 类 号：R743[医药卫生—神经病学与精神病学]