头颈部动脉夹层

Cervicocerebral Arterial Dissection

头颈部动脉夹层（Cervicocerebral arterial dissection，CAD）是指头颈部动脉内膜撕脱，导致血液流入血管壁内，形成壁内血肿。CAD病理生理机制目前尚未完全明确，可能与外伤、遗传、感染、偏头痛、吸烟、高血压及口服避孕药等因素有关。典型CAD表现为颈痛或头痛、Homer综合症、同侧颅神经麻痹、短暂性脑缺血发作（Transient Ischemic Attack，TIA）或卒中。影像学检查对CAD的诊断有重要价值，最常见的数字减影血管造影技术（Digital Subtraction Angiography，DSA）表现是“线样征”，特征性改变是“内膜瓣”或“双腔征”。CAD目前主要的治疗方法是药物治疗，常用抗凝或抗血小板药物治疗，少数患者经抗凝治疗6个月效果不佳，颈动脉夹层动脉瘤进一步扩大或夹层所致的高度狭窄进一步加重时，需外科手术干预。

Cervicocerebral arterial dissection （CAD）implies a intimal tear in the wall of cervicocerebral artery leading to the intrusion of blood into layers of the arterial wall （intramural haematoma）. The pathogenesis of CAD is incompletely understood. CAD has been reported in associations with trauma, genetic factors, infections, migraine, smoking, hypertension and contraceptive use. The clinical manifestations of CAD are neck pain and headache, partial Homer＇s syndrome,ipsilateral cranial nerve palsies, ipsilateral cerebral or retinal ischemia, Transient Ischemic Attack or stroke.Imaging examinations are very important for diagnosing CAD. The commonest finding on angiography is the so called＂string signal＂ - a long segment of narrowed lumen. The pathognomonic feature is intimal flap or double lumen. Treatment of CAD is essentially medical therapy, Anticoagulants and antiplatelet agents are commonly used in the treatment of CAD. When medical treatment with six month anticoagulation fails, carotid aneurysms or high grade stenosis become worse, CAD treated by surgical is needed.