脑动脉夹层临床分析

Clinical analysis of cerebral artery dissection

目的探讨脑动脉夹层的临床、影像学特征、内科治疗后血管再通的特点及临床预后的相关因素。方法回顾性分析2010年10月至2013年12月就诊于浙江大学医学院附属第一医院经DSA确诊的脑动脉夹层患者，记录患者的一般情况、神经功能缺损、影像学表现以及临床治疗方案，同时进行临床随访及统计学分析，记录其血管再通、临床预后等相关资料。结果28例脑动脉夹层患者中，颈动脉夹层最常见（19例，67．9％），其次为椎动脉夹层（7例，25．0％），颈动脉合并椎动脉较少见（2例，7．1％）。脑动脉夹层的影像学特点以线珠征和闭塞最为常见（15例，53．6％），其他依次为鼠尾征（7例，25．0％）、动脉瘤样扩张（4例，14．3％）和双腔征（2例，7．1％）。有18例脑动脉夹层患者发生急性脑梗死，但脑动脉夹层所致血管狭窄的程度与不同梗死形态之间差异无统计学意义。对所有患者均予规范的抗栓治疗，经抗血小板聚集和抗凝治疗后的血管再通率，其差异无统计学意义（5／6与9／13，P=0．37）。结论脑动脉夹层虽在临床上相对少见，但是该症典型的临床表现及特征性的影像学可以帮助诊断。规范化的内科治疗仍是脑动脉夹层的一线治疗方案。

Objective To investigate the clinical features, recanalization after medical treatment and clinical outcome of cerebral artery dissection. Methods We reviewed the clinical records of ischemic stroke patients with cerebral artery dissection who visited the First Affiliated Hospital of Zhejiang University between October 2010 and December 2013. We recorded patients＇ general information, neurological deficit, imaging and clinical treatment. We followed up the patients and statistically analyzed demographic data, recanalization and clinical outcome. Results Among 28 cases of cerebral artery dissection, carotid dissection was the most common （ n = 19, 67. 9% ）, followed by vertebral artery dissection （ n = 7, 25.0% ）, while the combination of carotid and vertebral artery dissection was rare （ n = 2, 7.1% ）. In the imaging of cerebral artery dissection, wire beads and occlusion were the most common signs （n = 15, 53.6% ）, followed by rat tail sign （ n = 7, 25.0% ）, aneurysmal dilatation （ n = 4, 14. 3% ） and dualchamber levy （n =2, 7. 1% ）. There were 18 cases of acute cerebral infarction in the 28 studied cases, but there was no significant difference between the degree of stenosis and cerebral infarction caused by cerebral artery dissection. All patients received standard antithrombotic therapy. The difference of the recanalization rate between using anti-platelet aggregation and anticoagulant therapy was not statistically significant （5/6 vs 9/13, P = 0. 37）. Conclusions Although cerebral artery dissection is relatively rare clinically, the typical clinical manifestations of the disease and the characteristic imaging are helpful for the diagnosis. Standardization of antithrombotic treatment is still the first-line treatment of cerebral artery dissection.