CAJ | 학술논문

目的：分析10例脑动脉夹层（CAD）患者的影像学特点及治疗情况。方法收集西安高新医院神经内科2006年6月—2013年1月收治10例 CAD 患者的临床资料，回顾性分析其一般资料、影像学检查结果、治疗结果及预后情况。结果10例患者中男6例，女4例；年龄15~62岁；有高血压病史者3例，吸烟史者5例，均无糖尿病家族史；自发性脑动脉夹层6例，创伤性脑动脉夹层4例（2例为脑血管介入治疗引起的并发症，2例为运动后创伤）；6例为颈动脉夹层，2例为大脑中动脉夹层，1例为椎动脉夹层，1例为大脑后动脉夹层。首次数字减影血管造影（DSA）检查结果显示：血管闭塞6例，其中左颈内动脉（LICA）C1段闭塞3例，左大脑中动脉（LMCA）M1段闭塞1例，右颈内动脉（RICA）C6段闭塞1例，右椎动脉（RVA）V1段闭塞1例；重度线样狭窄2例，其中右大脑中动脉（RMCA）M1远端狭窄1例，左大脑后动脉（LPCA）P2段狭窄1例；局部血管分层狭窄2例，其中 LICA C1段分层狭窄1例，LICA C2段内膜分层狭窄1例。经抗血小板聚集、抗凝、支架植入等治疗后，所有患者病变血管全部再通，血管形态均恢复正常。随访2年，磁共振血管造影（MRA）示所有患者血管形态稳定，未出现再发卒中或短暂性脑缺血发作。结论 DSA 检查结果显示双腔征和内瓣膜是 CAD 的特征性表现。目前对于抗凝治疗或是抗血小板聚集治疗仍存在争议，抗栓治疗仍是 CAD 确诊后的首选方案，治疗后需动态随访并及时复查 DSA，血管内支架治疗可作为药物治疗的补充。
목적：분석10례뇌동맥협층（CAD）환자적영상학특점급치료정황。방법수집서안고신의원신경내과2006년6월—2013년1월수치10례 CAD 환자적림상자료，회고성분석기일반자료、영상학검사결과、치료결과급예후정황。결과10례환자중남6례，녀4례；년령15~62세；유고혈압병사자3례，흡연사자5례，균무당뇨병가족사；자발성뇌동맥협층6례，창상성뇌동맥협층4례（2례위뇌혈관개입치료인기적병발증，2례위운동후창상）；6례위경동맥협층，2례위대뇌중동맥협층，1례위추동맥협층，1례위대뇌후동맥협층。수차수자감영혈관조영（DSA）검사결과현시：혈관폐새6례，기중좌경내동맥（LICA）C1단폐새3례，좌대뇌중동맥（LMCA）M1단폐새1례，우경내동맥（RICA）C6단폐새1례，우추동맥（RVA）V1단폐새1례；중도선양협착2례，기중우대뇌중동맥（RMCA）M1원단협착1례，좌대뇌후동맥（LPCA）P2단협착1례；국부혈관분층협착2례，기중 LICA C1단분층협착1례，LICA C2단내막분층협착1례。경항혈소판취집、항응、지가식입등치료후，소유환자병변혈관전부재통，혈관형태균회복정상。수방2년，자공진혈관조영（MRA）시소유환자혈관형태은정，미출현재발졸중혹단잠성뇌결혈발작。결론 DSA 검사결과현시쌍강정화내판막시 CAD 적특정성표현。목전대우항응치료혹시항혈소판취집치료잉존재쟁의，항전치료잉시 CAD 학진후적수선방안，치료후수동태수방병급시복사 DSA，혈관내지가치료가작위약물치료적보충。
Objective To analyze the imaging features and treatment of 10 patients with cerebral artery dissection. Methods Clinical data of 10 cerebral artery dissection patients admitted to the Department of Neurology,Gaoxin Hospital of Xi'an from June 2006 to January 2013 was collected,and general information,imaging findings,treatment outcome and prognosis were retrospectively analyzed. Results Of the 10 patients,6 cases were male,4 cases were female,aged at 15 to 62 years old,3 cases had positive hypertension history,5 cases had positive smoking history,but no one of them had positive family diabetic history;6 cases were spontaneous,4 cases were traumatic(2 cases caused by cerebrovascular intervention - induced complications,2 cases caused by post - exercise trauma);6 cases classified as caritid artery dissection,2 cases as middle cerebral artery dissection,1 case as vertebral artery dissection,1 case as posterior cerebral artery dissection. The first DSA examination results showed that:6 cases were with vessel occlusion( including 3 cases with occlusion of left internal carotid artery C1,1 case with occlusion of left main coronary artery M1,1 case with occlusion of right internal carotid artery C6,1 case with occlusion of right vertebral artery V1),2 cases with severe line - like stenosis(including 1 case with distal stenosis of right middle cerebral artery M1,1 case with stenosis of left posterior cerebral artery P2),2 cases with local vessel hierarchical stenosis(including 1 case with hierarchical stenosis of left internal carotid artery C1,1 case with intima hierarchical stenosis of left internal carotid artery C2). After treatment of anti - platelet aggregation,anticoagulation and stent implantation,all of the patients' affected vessels recanalizated,the shape returned to normal. After 2 years of fellow - up,MRA examination results showed that,all of the patients' vessel shape was stable,no one occurred recurrence of stroke or transient ischemic attack. Conclusion Double cavity sign and inside valve are characteristic features of DSA findings;antithrombotic therapy is the first choice of cerebral artery dissection,and dynamic follow - up and timely reexamination are necessary after treatment,but anticoagulation therapy and anti - platelet aggregation therapy are in dispute,intravascular stent implantation can assist the drug therapy.