支架置入术治疗症状性自发性颈动脉夹层的疗效分析

Efficacy analysis of stenting for symptomatic spontaneous carotid artery dissection

目的探讨血管内支架置入术治疗颈动脉夹层(CAD)的安全性和疗效。方法从南京卒中注册系统中,提取2005年5月—2010年12月经脑血管造影明确诊断的31例经抗栓治疗无效后行支架置入术的症状性自发性CAD患者的临床资料和随访数据。结果①在31例CAD患者中,30例支架置入手术成功,术中无并发症发生。术后即刻造影检查,29例CAD病变处狭窄完全消失,伴有夹层动脉瘤者动脉瘤明显缩小。2例患者于术后即刻出现术侧Horner征,其中1例伴有短暂性脑缺血发作(TIA),经抗栓治疗后完全缓解。②31例患者入院时NIHSS评分0分的有6例(19.4%,均为TIA患者),1～3分的有12例(38.7%),≥4分的有13例(41.9%),最高者1例为13分;中位数评分为2分。术后出院时NIHSS评分0分的有8例(25.8%),此8例患者入院时评分均≤4分。与入院时比较,有16例NIHSS评分无变化,占51.6%,且入院时评分均≤3分;有15例的评分呈不同程度下降,有2例2分者降为0分;下降最多的1例由13分降至4分;治疗前后评分的自身比较,采用McNemarχ2检验,χm2=14.062,P<0.01。③对29例手术成功的患者平均随访2.3年,无一例发生术侧血管缺血性事件。术后6～12个月对22例患者进行了DSA或CT血管成像的复查,CAD完全消失,无一例发生支架内再狭窄,伴有夹层动脉瘤者动脉瘤完全消失。结论血管内支架置入术治疗CAD是安全、有效的。

Objective To investigate the safety and efficacy of endovascular stenting in the treatment of carotid artery dissection（CAD）.Methods Thirty-one patients with clearly diagnosed symptomatic spontaneous CAD whose antithrombotic therapy was invalid were extracted from Nanjing Stroke Registry Program from May 2005 to December 2010.The clinical and follow-up data of the patients were collected.Results ①Of the 31 patients with CAD,30 achieved technical success without any intraoperative complications.The carotid artery stenosis at the CAD lesion disappeared completely immediately after stenting.The patients with dissecting aneurysm were improved significantly.Two patients had Horner sign at the operated sides immediately after surgery.One of them was accompanied by transient ischemic attack（TIA）,but it completely relieved after antithrombotic therapy.②At admission the NIHSS score was 0 in 6（19.4%） of the 31 patients（all TIA patients）,the scores were 0-3 of 12 patients（38.7%）,the scores were more than 4 in 13 patents（41.9%）,and the highest score of one patient was 13,the median score value was 2.At postoperative discharge,the score was 0 in 8 patients（25.8%）,all their scores were ≤4 at admission.Compared to the NIHSS scores at admission,the scores of did not have any change in 16 patients（51.6%）,and their scores at admission were ≤ 3.The scores of 15 patients decreased to varying degrees,and 2 patients with scores 2 decreased to 0;the largest decline of score in 1 patient was from 13 to 4.The scores before and after treatment were compared according to McNemar＇s χ2 test was χm2=14.062,P0.01.③29 patients with successful surgery were followed up for an average 2.3 years,and none of them had ischemic events on the operated sides.The DSA or CTA reexamination was conducted in 22 patients,Their CAD were disappeared completely.None of them had in-stent restenosis.The aneurysms disappeared completely in patients with dissecting aneurysm.Conclusion Endovascular stenting is safe and effective in the treatment of carotid artery dissection.