颈内动脉肌纤维发育不良的诊断及个体化治疗

The diagnosis and individualized treatment of fibromuscular dysplasia of internal carotid artery

目的 探讨颈内动脉肌纤维发育不良（FMD）患者的临床特征、诊断及治疗。方法 2011年1月至2012年6月收治5例FMD患者，均经DSA确诊，其中1例合并颅内动脉瘤。5例患者中，2例行颈内动脉闭塞治疗；1例合并颅内动脉瘤者行支架辅助栓塞动脉瘤，并口服抗血小板聚集药物治疗；2例单纯口服抗血小板聚集药物治疗。结果 5例患者均有颈内动脉壁不规则或串珠样改变，3例表现为双侧颈内动脉FMD，2例表现为单侧颈内动脉FMD。经相应治疗后，5例患者均未出现新的症状，原有症状缓解。患者经6个月 ~ 2年随访，未见缺血事件发生，合并颅内动脉瘤栓塞后未复发。结论 FMD临床诊断标准主要依靠DSA检查，治疗方案主要根据患者症状制定。

Objective To investigate the clinical characteristics, diagnosis and treatment of fibromnscnlar dysplasia （FMD） of internal carotid artery. Methods During the period from Jan. 2011 to June 2012 five patients with FMD of internal carotid artery were admitted to the hospital. The diagnosis was confirmed by DSA in all patients. In one case, the disease was complicated by intracranial aneurysm. Of the 5 patients, internal carotid artery occlusion therapy was carried out in 2, stent-assisted coil embolization of aneurysm together with anti- platelet medication was performed in one who had coexisting intracranial aneurysm, and only oral anti-platelet medication was employed in the remaining 2. Results The diagnosis was confirmed by DSA in all patients. DSA demonstrated irregular or string-of-beads shadow on the internal carotid artery wall. Bilateral internal carotid artery FMD was seen in 3 cases and unilateral internal carotid artery FMD was seen in 2 cases. After the treatment, the symptoms were improved in all cases, and no newly- developed symptoms were seen. During the follow- up period lasting for 6 - 24 months no ischemic events occurred and no recurrence of intracranial aneurysm after embolization. Conclusion Clinically, the diagnosis of FMD mainly depends on DSA findings, and the therapeutic scheme is mainly based on the patient＇s clinical symptoms.