自发性头颈动脉夹层与卒中相关的影像表现分析

Imaging analysis of spontaneous cervicocerebral artery dissection associated with stroke

目的以头颈动脉高分辨率磁共振成像(HR-MRI)为基础,探讨自发性头颈动脉夹层(cervicocerebral artery dissection,CCAD)患者与卒中相关的影像表现及危险因素。方法选取92例头颈动脉夹层患者,对患者进行为期3个月的随访,终点事件为出现缺血性卒中。以随访结果是否发生责任血管的卒中,将患者分为实验组和对照组。对比两组病例在年龄、性别、发病部位、累及血管节段数、狭窄程度、是否存在壁间血肿、附壁血栓及夹层动脉瘤等,以及HR-MRI的差异。结果通过分析发现,实验组患者在发病部位、累及血管节段数、狭窄程度、是否存在壁间血肿、附壁血栓、夹层动脉瘤等方面较对照组比较,差异有统计学意义(P<0.05);其中血管重度狭窄、累及节段数、存在壁间血肿、附壁血栓是卒中的独立风险因素。结论在CCAD患者中,具有壁间血肿、附壁血栓、夹层血管重度狭窄(狭窄程度>85%)、颈内动脉累及节段数均数为3.6、椎动脉累及节段数均数为2.8,更容易发生缺血性卒中,为卒中发生的独立高危因素。

Objective To investigate spontaneous cervicocerebral artery dissection(CCAD)based on high-definition magnetic resonance imaging(HR-MR)associated with stroke.Methods 92 patients with cervicocerebral artery dissection diagnosed in our hospital were followed up for 3 months.The end event was ischemic stroke.According to the follow-up results,the patients were divided into stroke group and non-stroke group(control group).The HR-MR images of the two groups were compared in terms of age,gender,location of onset,number of vascular segments involved,degree of stenosis,existence of intramural hematoma,mural thrombosis and dissecting aneurysm.Results Through analysis,it was found that in the stroke group,the location of onset,number of vascular segments involved,degree of severe stenosis,existence of intramural hematoma and mural thrombosis,dissecting aneurysms and other aspects were lower than those in the non-stroke group.There was significant difference(P<0.05),in which severe vascular stenosis,involving more than 3.6 segments,intramural hematoma and mural thrombosis,were independent risk factors for stroke.Conclusion For patients with cervicocerebral artery dissection,who have intramural hematoma,mural thrombosis and severe stenosis of dissecting vessels(stenosis degree>85%),the number of stages involved in internal carotid artery greater than 3.6,and the number of segments involved in vertebral artery greater than 2.8,are more prone to ischemic stroke,which is an independent high-risk factor for stroke.