外伤性颈内动脉闭塞致急性缺血性卒中:1例报告及文献复习

Acute ischemic stroke caused by traumatic internal carotid artery occlusion:One case report and literature review

目的:报道1例因外伤性颈内动脉闭塞致急性缺血性卒中患者的临床诊治经过,并对相关文献进行复习。方法:报道1例因外伤性颈内动脉闭塞致急性缺血性卒中患者的临床诊疗经过。同时,结合相关文献对外伤性颈内动脉闭塞的临床特征和诊治进展进行复习。结果:1例外伤性颈内动脉闭塞患者发生急性缺血性卒中而接受静脉溶栓治疗。治疗2周后,患者右侧肢体功能恢复,仅遗留部分运动性失语;美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分为2分。治疗6周后,复查颈动脉计算机断层摄影血管造影(computed tomography angiography,CTA),提示左侧颈总动脉近段狭窄,其远端颈总动脉闭塞直至颈总动脉分叉处。于是行左侧颈动脉内膜剥脱术+取栓术+颈动脉支架成形术。术后随访,患者预后良好。结论:对于外伤性颈内动脉闭塞致急性缺血性卒中的患者,可基于指南推荐,进行个体化治疗。在溶栓时间窗内及时进行静脉溶栓治疗,可以改善患者的预后。

Objective: To report the diagnosis and treatment of a patient with acute ischemic stroke caused by traumatic internal carotid artery occlusion, and review the related literatures.Methods: The clinical diagnosis and treatment of a patient with acute ischemic stroke caused by traumatic internal carotid artery occlusion was reported. The clinical characteristics of traumatic internal carotid artery occlusion and the related progress in diagnosis and treatment of this disease were reviewed.Results: A patients with acute ischemic stroke caused by traumatic internal carotid artery occlusion received intravenous thrombolysis. After 2-week treatment, the right limb function was recovered, only leaving moderate motor aphasia, and the National Institute of Health Stroke Scale(NIHSS) score was 2. After 6-week treatment, the carotid artery computed tomography angiography(CTA) suggested the proximal stenosis of left common carotid artery and the distal common carotid artery occlusion extending to the bifurcation of the common carotid artery. Then the left carotid endarterectomy was performed with embolectomy and carotid angioplasty and stenting. After operation, the patient was followed-up, and the prognosis was good.Conclusion: For patients with acute ischemic stroke caused by traumatic internal carotid artery occlusion, individualized treatment is recommended on the basis of guidelines. The thrombolytic therapy in time window can improve the prognosis of the patients.