CAJ | 학술논문

目的探讨脑动脉夹层治疗的方法.方法 2009年10月至2011年11月收治经全脑血管造影明确诊断为脑动脉夹层患者8例,给予抗凝、抗血小板治疗,短期内给予复查脑血管造影,若出现血管狭窄进一步加重,则给予介入支架治疗,所有患者治疗后最少经3个月进行复查,根据美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分和全脑血管造影从影像学和临床神经功能改善状况对治疗效果进行评估.结果 8例患者中6例颈动脉夹层,2例椎动脉夹层;入院后给予抗凝治疗4例,抗血小板治疗4例,治疗10～14 d后复查造影,其中3例因血管狭窄程度加重或在药物治疗期间出现新发梗死或仍有反复脑缺血发作(TIA),给予支架治疗.经个体化治疗后,随访期内均未出现新发梗死及TIA复发.8例患者NIHSS评分平均值治疗前后分别为5.9、1.6分,mRS评分平均值治疗前后分别为2.5、0.9分.结论针对脑动脉夹层的治疗,介入治疗应个体化,在急性期应给予抗凝或抗血小板药物治疗并短期行脑血管造影,根据临床表现和脑血管造影显示血管狭窄变化,治疗并短期随访,制定下一步治疗方案.
목적 탐토뇌동맥협층치료적방법.방법 2009년10월지2011년11월수치경전뇌혈관조영명학진단위뇌동맥협층환자8례,급여항응、항혈소판치료,단기내급여복사뇌혈관조영,약출현혈관협착진일보가중,칙급여개입지가치료,소유환자치료후최소경3개월진행복사,근거미국국립위생연구원졸중량표(NIHSS)평분、개량Rankin량표(mRS)평분화전뇌혈관조영종영상학화림상신경공능개선상황대치료효과진행평고.결과 8례환자중6례경동맥협층,2례추동맥협층;입원후급여항응치료4례,항혈소판치료4례,치료10～14 d후복사조영,기중3례인혈관협착정도가중혹재약물치료기간출현신발경사혹잉유반복뇌결혈발작(TIA),급여지가치료.경개체화치료후,수방기내균미출현신발경사급TIA복발.8례환자NIHSS평분평균치치료전후분별위5.9、1.6분,mRS평분평균치치료전후분별위2.5、0.9분.결론 침대뇌동맥협층적치료,개입치료응개체화,재급성기응급여항응혹항혈소판약물치료병단기행뇌혈관조영,근거림상표현화뇌혈관조영현시혈관협착변화,치료병단기수방,제정하일보치료방안.
Objective To explore the best treatment method of cerebral artery dissection.Methods This study included eight patients who were definitely diagnosed as cerebral artery dissection by the cerebral angiography in our department of neurology during Oct.2009 and Nov.2011.They were all treated by the anticoagulation or anti-platelet methods.Some patients received the stent therapy.All patients' were followed for at least three months. The treatment effect was assessed by NIHSS,mRS and by the cerebral angiography.Results Six patients had carotid artery dissection,2 had vertebral artery dissection.Four patients were given anticoagulant therapy and the other 4 were given anti-platelet therapy. The reexamination by angiography 10-14 days after admission showed that in 3 patients,the stenosis was aggravated or the infarction occurred.They were diagnosed as having repeated transient ischemic attack (TIA) during pharmacotherapy and received stents for treatment.There was no TIA and cerebral infarction in the follow-up period after individualized therapy.Mean NIHSS scores of 8 patients between pre and post treatment were 5.9,1.6 respectively. Mean mRS scores pre and post treatment were 2.5,0.9respectively.Conclusion The treatment for patients with cerebral artery dissection should be individuated.The patients in acute stage should get anticoagulation,anti-platelet therapy and angiography re-examination.According to the clinical manifestation and cerebral angiography,the next step for the treatment should be done.