颈动脉蹼的临床特点及其所致缺血性脑卒中的防治措施分析

Clinical characteristics of carotid webs and prevention measurements of cerebral ischemic stroke caused by carotid webs

目的探讨颈动脉蹼的临床特点及其所致的缺血性脑卒中的防治措施。方法回顾性收集武汉大学中南医院神经内科自2017年10月至2019年1月收治的3例颈动脉蹼患者的临床资料,并结合PubMed、Embase、万方和中国知网数据库自2014年1月1日至2019年6月30日收录的关于颈动脉蹼的文献报道(含208例颈动脉蹼患者),分析颈动脉蹼的人口学特征、临床特点及其所致的缺血性脑卒中的二级预防措施。结果211例颈动脉蹼患者中男性68例(32.2%)、女性143例(67.8%),中位年龄48岁。148例患者被报道了有血管危险因素,其中高血压43例(29.1%)、高脂血症19例(12.8%)、糖尿病14例(9.5%)、吸烟12例(8.1%)。89.8%(44/49)的颈动脉蹼引起血管腔轻度狭窄(狭窄程度<50%)。在颈动脉蹼所致的缺血性脑卒中的二级预防中,抗凝或抗凝+抗血小板治疗的缺血性脑卒中复发率显著低于单纯抗血小板治疗(11.1%vs.49.3%);23例行颈动脉内膜剥脱术的患者和54例行颈动脉支架植入术的患者分别在平均12个月(1~60个月)和平均11个月(3~144个月)的随访期内均未出现缺血性脑卒中事件及手术相关并发症。结论颈动脉蹼是隐源性脑卒中的重要危险因素。抗凝或抗凝+抗血小板治疗预防缺血性脑卒中复发的疗效优于单纯抗血小板治疗。对缺血性脑卒中复发风险较高的颈动脉蹼患者,颈动脉内膜剥脱术和颈动脉支架植入术均是理想的二级预防措施。

Objective To investigate the clinical characteristics of carotid webs and prevention measurements of cerebral ischemic stroke caused by carotid webs.Methods The clinical data of three patients with carotid webs admitted to our hospital from October 2017 to January 2019 were retrospectively studied,and publications(208 patients with carotid webs)reported from January 1,2014 to June 30,2019 in PubMed,Embase,Wanfang and CNKI databases were collected.The demographic and clinical characteristics of carotid webs and secondary prevention measurements of ischemic stroke caused by carotid webs were analyzed.Results A total of 211 patients with carotid webs were enrolled,including 68 male(32.2%)and 143 female(67.8%),with an median age of 48 years.Prevalence of risk factors for cerebrovascular disease reported in 148 patients was as follows:hypertension(n=43,29.1%),dyslipidemia(n=19,12.8%),diabetes mellitus(n=14,9.5%),and smoking(n=12,8.1%);89.8%of carotid webs(44/49)caused mild stenosis of carotid artery(stenosis degree<50%).In secondary stroke prevention,the recurrence rate of stroke patients treated with anticoagulation plus antiplatelet was obviously lower than that of patients treated with antiplatelet alone(11.1%vs.49.3%).No ischemic stroke or surgical complications were noted in 23 patients underwent carotid endarterectomy and 54 patients underwent carotid stent implantation during the mean follow-up period of 12 months(one-60 months)and 11 months(3-144 months),respectively.Conclusions Carotid web may be a vital risk factor for cryptogenic stroke.Anticoagulation plus antiplatelet is superior to antiplatelet alone in preventing stroke recurrence.Carotid endarterectomy and carotid stent implantation may be the perfect choices for carotid web patients with high risk of stroke recurrence.