颈动脉蹼相关性脑梗死的临床特点  

Clinical characteristics of carotid web-related ischemic stroke

作　　者：田晓洁 刘然[1] 陶昀璐[1] 雷娜[1] 杨洁[1] 王臣[2] 马妍[3] 邢英琦[1] Tian Xiaojie;Liu Ran;Tao Yunlu;Lei Na;Yang Jie;Wang Chen;Ma Yan;Xing Yingqi(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Radiology and Nuclear Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053 [2]首都医科大学宣武医院放射与核医学科,北京100053 [3]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华神经科杂志》2023年第11期1270-1277,共8页Chinese Journal of Neurology

摘　　要：目的分析颈动脉蹼相关性脑梗死的临床特征和治疗方案,梳理颈动脉蹼相关性脑梗死的诊疗流程。方法对2018年1月至2022年9月就诊于首都医科大学宣武医院的6例颈动脉蹼相关性脑梗死患者的临床表现、头颅磁共振成像(MRI)、CT血管成像(CTA)/数字减影血管造影(DSA)、颈动脉超声检查、经颅彩色多普勒超声特点进行分析总结,并总结其治疗和随访情况。结果6例患者均为中青年,无传统脑血管病危险因素,男女比例2∶4。所有患者均有反复脑卒中发作,发病时美国国立卫生研究院卒中量表评分2~4分。头颅MRI显示5例患者大脑中动脉供血区域梗死,1例患者颅内无梗死灶。6例患者颈动脉蹼处血管均无明显狭窄。4例患者伴有同侧大脑中动脉狭窄或闭塞,1例患者于大脑中动脉发现微栓子信号,1例患者颅内动脉未见明显异常。6例患者均由脑颈血管超声初诊,经CTA/DSA确认5例,1例无异常发现。6例患者均接受颈动脉内膜切除术并做病理检查确诊。术后均规律抗血小板聚集、他汀类降脂治疗,随访0.5~5.2年,均无卒中再发。结论作为隐源性脑卒中的罕见病因,颈动脉蹼相关脑卒中的复发率较高。对于无传统脑血管病危险因素的卒中患者,反复出现颈内动脉系统栓塞性事件,应注重颈脑联合、综合血流动力学特点排查有无颈动脉蹼;颈脑血管超声联合其他影像学方法可以提高颈动脉蹼的检出率;单纯抗血小板聚集治疗不能有效预防卒中再发,对于确诊的颈动脉蹼相关性脑梗死患者可选择手术切除,并用颈脑血管超声评估治疗效果。Objective To analyze the clinical characteristics and management strategy of carotid web(CW)-related stroke and improve the understanding of CW.Methods The clinical data of 6 patients with CW-related stroke treated at Xuanwu Hospital,Capital Medical University,from January 2018 to September 2022 were retrospectively analyzed.Relevant data included clinical manifestations,bronchial magnetic resonance imaging(MRI),CT angiography(CTA)/digital subtraction angiography(DSA),carotid ultrasonography,and transcranial color-coded Doppler sonography(TCCD).Treatments and follow-ups were also reported.Results All 6 patients were middle-aged or young,without traditional risk factors for cerebrovascular disease.The male-to-female ratio was 2∶4.All patients had recurrent strokes,with a score of 2-4 on the National Institutes of Health Stroke Scale at the time of onset.Head MRI showed 5 patients with cerebral infarction in the middle cerebral artery supply area;1 patient had no intracranial infarction.No significant stenosis of the vessels at the site of the CW was observed in any of the 6 patients.Four patients had ipsilateral stenosis or occlusion of the middle cerebral artery,1 patient had microembolic signals in the middle cerebral artery,and 1 patient had no significant abnormalities in the intracranial artery.All 6 patients were initially diagnosed by ultrasound.Diagnoses were confirmed by CTA/DSA in 5 cases;the other patient did not show any significant abnormalities.All 6 patients underwent a carotid endarterectomy after a pathological examination to confirm the diagnosis.Postoperatively,regular antiplatelet aggregation and statin lipid-lowering therapies were administered.A follow-up of 0.5 to 5.2 years showed no stroke recurrence in any patient.Conclusions CW-related stroke is a rare cause of cryptogenic stroke and has a high recurrence rate.For stroke patients who do not have traditional risk factors for cerebrovascular disease while repeatedly experiencing embolic events of the internal carotid artery system,attenti

关 键 词：卒中 颈动脉 超声检查 多普勒 彩色 颈动脉内膜切除术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]