存在颈动脉蹼的缺血性脑卒中患者临床特点

Clinical characteristics of ischemic stroke patients with carotid web

目的分析存在颈动脉蹼(CW)的缺血性脑卒中(脑梗死)患者的临床特点。方法回顾性分析40000例接受头颈部CT血管造影(CTA)患者的影像学及临床资料,观察存在CW的脑梗死患者的临床特点。结果头颈部CTA检出114例(114/40000,0.29%)CW,均为脑梗死患者,包括腔隙性脑梗死70例及大面积脑梗死44例;86例单侧、28例双侧颈动脉存在CW;共检出142个CW,其中位于颈内动脉起始部96个,C1段中段及C2段各4个,颈动脉球33个,颈总动脉中段2个,颈外动脉起始部、颈总动脉起始部及椎动脉颅内段各1个。腔隙性脑梗死及大面积脑梗死患者之间,心房颤动(房颤)及烟雾病占比差异均有统计学意义(P均<0.05)。排除7例房颤及1例烟雾病后,106例中,双侧颈内动脉CW患者中,缺血侧CW长度>5 mm者占比高于CW位于颈动脉球者(P=0.02)。24例双侧CW患者中,大面积脑梗死14例、腔隙性脑梗死10例。82例单侧CW患者中,大面积脑梗死24例、腔隙性脑梗死58例,两种疾病分布差异有统计学意义(P=0.01)。42例以偏侧肢体活动障碍为主要症状患者中,31例缺血侧明确,其中CW长度>5 mm者22例、≤5 mm者9例;11例未明确缺血侧,CW长度>5 mm者3例、≤5 mm者8例,CW长度分布差异有统计学意义(P=0.03)。结论CW具有典型影像学表现,多位于单侧颈内动脉;双侧较单侧CW患者更易出现大面积脑梗死,缺血侧CW长度>5 mm者较≤5 mm更易发生偏侧肢体活动障碍。

Objective To observe the clinical characteristics of ischemic stroke(cerebral infarction)patients with carotid web(CW).Methods Imaging and clinical data of 40000 subjects who undergoing head and neck CT angiography(CTA)were retrospectively analyzed,and the clinical characteristics of cerebral infarction patients with CW were observed and analyzed.Results Head and neck CTA detected CW in 114 cases of cerebral infarction,with the detection rate of 0.29%(114/40000),including 70 cases of lacunar infarction and 44 of large-area cerebral infarction.A total of 142 CW were found in unilateral carotid arteries of 86 cases and bilateral carotid arteries of 28 cases,96 locating at the origin of the internal carotid artery,4 at middle of C1 segment and 4 at C2 segment of the internal carotid artery,33 at carotid bulb,2 in middle segment of the common arteries,1 at the origin of the external carotid artery,1 at the origin of the common carotid artery and 1 at the intracranial segment of vertebral artery.There were significant differences of atrial fibrillation(AF)and moyamoya disease between patients with large-area cerebral infarction and lacunar infarction with CW(both P<0.05).After exclusion of 7 cases of AF and 1 case of moyamoya disease,among the remaining 106 patients,the proportion of CW length>5 mm on the ischemic side in patients with both sides CW at the internal carotid arteries was higher than that in patients with both sides CW at the carotid bulb(P=0.02).Among 24 patients with bilateral CW,large cerebral infarction occurred in 14 cases,while lacunar infarction occurred in 10 cases,whereas among 82 patients with unilateral CW,large cerebral infarction occurred in 24 and lacunar infarction occurred in 58 cases,there were significant differences of the types of infarctions(P=0.01).Among 42 patients with unilateral limb movement disorder as the main symptom,the ischemic side was clear in 31 cases,including 22 with CW length>5 mm and 9 with CW length≤5 mm.The ischemic side could not be identified in 11 cases,including 3 cases with CW length>5 mm and 8 with CW length≤5 mm,there were statistically differences of CW length(P=0.03).Conclusion CW had typical imaging manifestations,mostly located in unilateral internal carotid artery.Patients with bilateral CW were more likely to occur large-area cerebral infarction than with unilateral CW,with CW length>5 mm on ischemic side were more likely to develop unilateral limb movement disorder than with CW≤5 mm.