自发性颈内动脉夹层继发颅内扩展的介入治疗
Interventional management for secondary intracranial extension of spontaneous cervical arterial dissection.
作者信息
Smith Michelle J, Santillan Alejandro, Segal Alan, Patsalides Athos, Gobin Y Pierre
机构信息
Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
出版信息
Surg Neurol Int. 2010 Dec 17;1:82. doi: 10.4103/2152-7806.74092.
BACKGROUND
Spontaneous cervical artery dissection (sCAD) is an important etiology of stroke and subarachnoid hemorrhage (SAH) in young patients. Anticoagulation and platelet antiaggregant medications are the treatment of choice, while the indications of endovascular treatment are still to be defined.
CASE DESCRIPTION
We report two cases of medically refractory sCAD with intracranial extension treated successfully with multiple intra and extracranial stents. The patients were evaluated at 4 years and 1-year follow-up.
CONCLUSION
Progressive, spontaneous cervical artery dissection with intracranial extension despite adequate medical therapy is rare and associated with worse prognosis. Given the rapid evolution of interventional technology and techniques, if we are better able to predict the cohort of patients that fail medical management, earlier endovascular therapy may be considered.
背景
自发性颈内动脉夹层（sCAD）是年轻患者发生卒中及蛛网膜下腔出血（SAH）的重要病因。抗凝及抗血小板药物是主要治疗手段，而血管内治疗的指征仍有待明确。
病例描述
我们报告两例药物治疗效果不佳且伴有颅内延伸的sCAD患者，通过多枚颅内及颅外支架成功治疗。对患者进行了4年及1年的随访评估。
结论
尽管进行了充分的药物治疗，但仍进展的、伴有颅内延伸的自发性颈内动脉夹层较为罕见，且预后较差。鉴于介入技术的快速发展，如果我们能更好地预测药物治疗效果不佳的患者群体，可考虑早期进行血管内治疗。
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