颈动脉夹层的临床特点、治疗方式及预后分析  

Clinical characteristics, treatments and prognoses of carotid artery dissection

作　　者：尹延伟 张光运 陈大伟 石进 张艺耀 张莹 杨芬 Yin Yanwei;Zhang Guangyun;Chen Dawei;Shi Jin;Zhang Yiyao;Zhang Ying;Yang Fen(Department of Neurology,Air Force Medical Center of PLA,Beijing 100142,China)

机构地区：[1]中国人民解放军空军特色医学中心神经内科,北京100142

出　　处：《中华神经医学杂志》2025年第1期60-64,共5页Chinese Journal of Neuromedicine

基　　金：北京市科技新星计划基金(Z171100001117094)。

摘　　要：目的分析颈动脉夹层(CAD)的临床特点、治疗方式及预后。方法选择中国人民解放军空军特色医学中心神经内科自2010年5月至2024年4月收治的9例CAD患者为研究对象。回顾性分析患者的临床和影像学资料、治疗方式和预后[改良Rankin量表(mRS)评分≤2分定义为预后良好]。结果(1)9例CAD患者中高血压病史3例,糖尿病史2例,头颈部外伤史4例,放疗病史1例,既往史不明确1例。9例患者行颈动脉超声检查,结果显示7例患者颈内动脉血流速度慢、伴狭窄或者闭塞,2例患者颈内动脉血流未见明显异常;5例患者行MRA检查,结果显示颈内动脉严重狭窄或者次全闭塞;8例患者行DSA检查,结果显示CAD并严重狭窄或者次全闭塞。(2)3例患者经抗血小板、2例患者经抗凝治疗无效后予颈动脉支架成形术(CAS),1例患者直接予CAS治疗,3例患者予抗凝治疗。(3)治疗后3个月9例患者均预后良好。4例患者复查颈动脉超声显示血管再通,3例患者复查MRA显示血管再通,1例患者复查DSA显示血管再通,1例患者复查CTA显示右侧颈内动脉中度狭窄。结论CAD原因多样,对颈部外伤合并脑卒中患者要高度警惕CAD的可能。抗血小板治疗、抗凝治疗效果不佳时可考虑及时行血管内治疗。Objective To analyze the clinical characteristics,treatments and prognoses of carotid artery dissection(CAD).MethodsNine patients with CAD,admitted to Department of Neurology,Air Force Medical Center of PLA from May 2010 to April 2024,were chosen;the clinical and imaging data,treatments and prognoses(mRS score≤2:good prognosis)of the patients were retrospectively analyzed.Results(1)Among the 9 patients with CAD,histories of hypertension,diabetes,head and neck trauma,and radiotherapy were noted 3,2,4 and 1 patients,respectively;and unclear past history was noted in 1 patient.Carotid ultrasound was performed in 9 patients:slow blood flow of the internal carotid artery with stenosis or occlusion in 7 patients and normal blood flow of the internal carotid artery in 2 patients were noted.MRA in 5 patients showed severe stenosis or subtotal occlusion in the internal carotid artery.DSA in 8 patients showed CAD plus severe stenosis or subtotal occlusion.(2)After ineffective antiplatelet therapy in 3 patients and ineffective anticoagulant therapy in 2 patients,carotid artery stenting(CAS)was performed;direct CAS was given in one patient,and anticoagulant therapy was given in 3 patients.(3)After 3 months of treatment,9 patients had a good prognosis;carotid ultrasound in 4 patients showed vascular recanalization;MRA re-examination in 3 patients showed vascular recanalization.DSA re-examination in 1 patient showed vascular recanalization;CTA re-examination in 1 patient showed moderate stenosis of the right internal carotid artery.ConclusionCAD causes are various;CAD should be considered in patients with neck trauma combined with stroke;endovascular treatment should be considered when antiplatelet/anticoagulant therapy are not effective.

关 键 词：颈动脉夹层 内科治疗 血管内治疗 

分 类 号：R743[医药卫生—神经病学与精神病学]