Cohen José E, Ben-Hur Tamir, Gomori John M, Umansky Felix, Lylyk Pedro, Rajz Gustavo
Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel.
Neurol Res. 2005;27 Suppl 1:S73-8. doi: 10.1179/016164105X35440.
Dissection of the internal carotid artery is a well-recognized complication of craniocervical trauma with potentially grave neurological outcome in patients with significant ischemic symptoms. Traditional anticoagulation therapy may not be applicable, since anticoagulation is contraindicated in multiple trauma or penetrating injuries. In these circumstances, rapid stenting followed by antiplatelet therapy may be performed.
Patients with angiographically proven traumatic carotid artery dissection were prospectively selected for endovascular stenting according to clinical and radiological criteria. Essentially, patients with hemodynamic significant hemispheric hypoperfusion (as indicated by angiography or perfusion MRI), or in whom anticoagulant therapy failed clinically, or anticoagulation was contraindicated, were considered at high risk for stroke and were selected for stenting. Twelve patients were selected for stenting.
In seven patients, multiple stents were implanted. Endovascular treatment reduced mean dissection stenosis from mean 65+/-33% (range, 10-100%) to mean 7+/-9% (range, 20-0%). In a mean clinical follow-up of 11.5+/-6.3 months (range 3-24 months), eight patients improved and four remained stable, and none of the patients had a TIA or stroke. Doppler U/S studies did not detect any signs of de novo in-stent stenosis in any of the patients at a mean follow-up time of 9.2+/-6.4 months.
In selected cases of traumatic dissections of the carotid artery, endovascular stent-assisted angioplasty may immediately restore the integrity of the vessel lumen, even of acutely occluded arteries. This approach efficiently prevented the occurrence of new ischemic events, without additional anticoagulation.
颈内动脉夹层是颅颈创伤公认的并发症，对于有明显缺血症状的患者，可能会导致严重的神经功能后果。传统的抗凝治疗可能不适用，因为在多发伤或穿透伤中抗凝是禁忌的。在这些情况下，可先进行快速支架置入，然后进行抗血小板治疗。
根据临床和影像学标准，对经血管造影证实为创伤性颈动脉夹层的患者进行前瞻性选择，以进行血管内支架置入。本质上，血流动力学上有明显半球灌注不足的患者（如血管造影或灌注磁共振成像所示），或抗凝治疗在临床上失败的患者，或抗凝禁忌的患者，被认为有中风的高风险，并被选择进行支架置入。12名患者被选择进行支架置入。
7名患者植入了多个支架。血管内治疗使平均夹层狭窄率从平均65±33%（范围10 - 100%）降至平均7±9%（范围0 - 20%）。平均临床随访11.5±6.3个月（范围3 - 24个月），8名患者病情改善，4名患者病情稳定，所有患者均未发生短暂性脑缺血发作或中风。在平均随访时间9.2±6.4个月时，多普勒超声检查未在任何患者中检测到新的支架内狭窄迹象。
在选定的颈动脉创伤性夹层病例中，血管内支架辅助血管成形术可立即恢复血管腔的完整性，即使是急性闭塞的动脉。这种方法有效地预防了新的缺血事件的发生，无需额外的抗凝治疗。
