颈动脉夹层42例的临床特点、治疗及再通随访

Cervical artery dissection: clinical characteristics,treatmentand recanalization follow-up in 42 patients

目的探讨颈动脉夹层的临床特点及治疗,通过超声随访分析血管再通的相关性因素。方法连续收集2013-06~2015-10就诊于山西医科大学第一医院神经内科因颈动脉夹层导致的急性脑卒中或短暂性脑缺血发作(transient ischemic attack,TIA)患者的临床资料,并对纳入研究的患者进行3-6个月的超声随访,临床预后采用美国国立卫生研究院脑卒中量表(NIHSS)进行评估。结果 42例颈动脉夹层患者中,颈内动脉夹层35例(83.3%),椎动脉夹层7例(16.7%)。首发症状以一侧肢体无力伴言语障碍多见,其次为头痛,但大部分(69.0%)患者脑卒中前无任何先兆症状。因颈动脉夹层所致的急性脑梗死39例(92.9%),TIA3例(7.1%)。药物治疗以阿司匹林联合氯吡格雷治疗为主(50%)。所有患者在治疗后NIHSS评分均有所降低,且在随访期间未出现新的缺血性事件。颈部血管超声随访中共有13例(31.0%)发生再通,再通时间8 d至6月不等。再通与非再通者之间相关性因素无显著差异。结论 (1)颈动脉夹层临床表现多样,确诊前多已发展为脑卒中。(2)再通率的影响因素尚不明确,可能与高血压有关,需设计更严密的研究方案进行论证。

Objective To explore the clinical characteristics and treatment of cervical artery dissection（ CAD）,and analyze the influential factors of recanalization assessed by ultrasound follow-up. Methods From June 2013 to October 2015,42 consecutive patients with acute stroke or transient ischemic attack following occlusion or stenosis due to CAD admitted in the Department of Neurology,First Hospital of Shanxi Medical University were enrolled in this study. All the patients were evaluated by neurovascular ultrasound in hospital and in 3-6 months after discharge. At the same time the neurological deficits were assessed using the National Institutes of Health Stroke Scale（ NIHSS）. Results Among 42 cases of CAD,35 cases（ 83. 3%） were internal carotid artery dissection and 7 cases（ 16. 7%） were vertebral artery dissection. The main initial symptom was unilateral limb weakness with speech disorder,followed by headache,but most of the patients（ 69. 0%） had no aura symptoms before stroke. Of 42 patients,there were 39 patients with ischemic stroke and 3 patients with TIA. Most patients（ 50%） were treated with aspirin and clopidogrel. The NIHSS score of all the patients after treatment were decreased,and no new ischemic events happened during the follow-up period. Arterial recanalization occurred in 13 of42 patients during the follow-up and the recanalization time varied from 8 d to 6 months. There was no significant difference for general risk factors between patients with and without recanalization. Conclusion（1）The clinical manifestation of CAD is various,and it often develops a stroke before being diagnosed.（2）The associated factors of recanalization remains unclear,but it may be associated with the high blood pressure statement after CAD,which still needs to be proven by further strictly designed studies.