Cohen José E, Ben-Hur Tamir, Rajz Gustavo, Umansky Felix, Gomori John M
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Stroke. 2005 Apr;36(4):e45-7. doi: 10.1161/01.STR.0000158910.08024.7f. Epub 2005 Mar 3.
The prognosis of traumatic dissection of the internal carotid artery is worse than for spontaneous dissections. Rapid stenting followed by antiplatelet therapy may prevent complications when anticoagulation therapy is not applicable.
Patients with angiographically proven traumatic carotid artery dissection and hemodynamic significant hemispheric hypoperfusion, or in whom anticoagulant therapy was either contraindicated or failed clinically, were regarded as being at high risk for stroke and were selected for stenting.
Ten patients with traumatic dissection underwent stenting. Endovascular treatment reduced mean dissection stenosis from 69% to 8%. During a mean clinical follow-up time of 16 months, none had additional transient ischemic attacks or stroke. Doppler ultrasound studies did not detect any signs of de novo in-stent stenosis.
In selected cases of traumatic carotid artery dissections, endovascular stent-assisted angioplasty immediately restored the integrity of the vessel lumen and prevented efficiently the occurrence of new ischemic events, without additional anticoagulation.
颈内动脉创伤性夹层的预后比自发性夹层更差。当抗凝治疗不适用时，快速支架置入并联合抗血小板治疗可能预防并发症。
血管造影证实为创伤性颈动脉夹层且存在血流动力学显著的半球性灌注不足，或抗凝治疗禁忌或临床治疗失败的患者，被视为卒中高危患者并入选接受支架置入术。
10例创伤性夹层患者接受了支架置入术。血管内治疗使平均夹层狭窄率从69%降至8%。在平均16个月的临床随访期内，无患者发生额外的短暂性脑缺血发作或卒中。多普勒超声检查未发现任何新的支架内狭窄迹象。
在部分创伤性颈动脉夹层病例中，血管内支架辅助血管成形术可立即恢复血管腔的完整性，并有效预防新的缺血事件发生，无需额外抗凝。
