6例自发性颅外段颈内动脉夹层腔内治疗中期临床效果观察

Endovascular repair of spontaneous extracranial internal carotid artery dissection: observation of mid-term clinical effect in 6 patients

目的初步观察自发性颅外段颈内动脉夹层腔内治疗的中期临床疗效及支架内通畅情况。方法回顾性分析接受腔内治疗的自发性颅外段颈内动脉夹层患者临床资料及影像学随访资料,对比分析腔内治疗前后及末次随访时美国国立卫生研究院卒中量表(NIHSS)评分及支架内通畅情况。结果2012年3月至12月共6例自发性颅外段颈内动脉夹层患者接受腔内治疗,其中男4例,女2例,中位年龄50岁(40.75~54.75岁),发病至接受腔内治疗中位时间为10 d(1周至3个月)。所有患者支架植入后夹层真腔血流立即恢复,部分假腔内仍有对比剂充盈;1例术中出现视网膜动脉栓塞,无死亡患者。中位随访时间54.4个月(49.7~57.9个月),末次随访时NIHSS评分与术前相比,差异均无统计学意义(P=0.102);影像学复查可见颈内动脉支架段假腔均消失,支架内无明显狭窄。结论采用裸支架对部分有症状的自发性颅外段颈内动脉夹层进行腔内治疗,可有效防止临床症状复发,随访发现夹层重塑良好并保持支架内通畅。

Objective To preliminary evaluate the mid-term clinical effect of endovascular repair in treating spontaneous extraeranial internal carotid artery （ICA） dissection, and to observe the patency of stent. Methods The clinical data and imaging materials of 6 patients with spontaneous extracranial ICA dissection, who were treated with endovascular repair during the period from March 2012 to December 2012, were retrospectively analyzed. The U.S. National Institute of Health Stroke Scale （NIHSS） scores were determined before and after endovascular repair, and the postoperative stent patency condition was assessed, the results were analyzed. Results A total of 6 patients, including 4 males and 2 females with a median age of 50 years old （40.75-54.75 years old）, received endovaseular repair therapy. The median interval from the onset of disease to accept endovascular treatment was 10 days （one week- 3 months）. After the implantation of stent, the blood flow in the true lumen returned to normal immediately, although part of the false lumen was still filled with contrast agent. Embolism of retinal artery occurred in one patient during the operation, no death occurred. The median follow-up time was 54.4 months （49.7-57.9 months）. The NIHSS score determined at the last follow-up visit was not significantly different from the preoperative one （P=0.102）. Imaging reexamination revealed that the false lumen at the ICA stent segment disappeared in all 6 patients, and no obvious in-stent stenotic changes were observed. Conclusion Endovascular therapy of selected symptomatic extraeranial carotid artery dissection with bare stents can effectively prevent the recurrenee of clinical symptmns and promote ICA remodeling with excellent mid-term patency.