Department of Neurological Surgery, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois 60611, USA.
Neurosurgery. 2011 Apr;68(4):856-66; discussion 866. doi: 10.1227/NEU.0b013e318209ce03.
Carotid and vertebral artery dissections are a leading cause of stroke in young individuals.
To examine the published safety and efficacy of endovascular stenting for extracranial artery dissection.
We conducted a systematic review of the literature to identify all cases of endovascular management of extracranial carotid and vertebral artery dissections.
For carotid dissections, our review yielded 31 published reports including 140 patients (153 vessels). Reported etiologies were traumatic (48%, n = 64), spontaneous (37%, n = 49), and iatrogenic (16%, n = 21). The technical success rate of stenting was 99%, and the procedural complication rate was 1.3%. Mean angiographic follow-up was 12.8 months (range, 2-72 months) and revealed in-stent stenosis or occlusion in 2% of patients. Mean clinical follow-up was 17.7 months (range, 1-72 months), and neurological events were seen in 1.4% of patients. For vertebral artery dissections, our review revealed 8 reports including 10 patients (12 vessels). Etiologies were traumatic (60%, n = 6), spontaneous (20%, n = 2), and iatrogenic (20%, n = 2). There was a 100% technical success rate. The mean angiographic follow-up period was 7.5 months (range, 2-12 months). No new neurological events were reported during a mean clinical follow-up period of 26.4 months (range, 3-55 months).
Endovascular management of extracranial arterial dissection continues to evolve. Current experience shows that this treatment option is safe and technically feasible. Prospective randomized trials compared with medical management are needed to further elucidate the role of stenting.
颈动脉和椎动脉夹层是年轻人中风的主要原因。
研究血管内支架治疗颅外动脉夹层的安全性和有效性。
我们对文献进行了系统回顾，以确定所有颅外颈动脉和椎动脉夹层血管内治疗的病例。
对于颈动脉夹层，我们的综述共包括 31 项已发表的报告，涉及 140 例患者（153 支血管）。报告的病因有创伤性（48%，n=64）、自发性（37%，n=49）和医源性（16%，n=21）。支架置入的技术成功率为 99%，手术并发症发生率为 1.3%。平均血管造影随访时间为 12.8 个月（范围，2-72 个月），发现 2%的患者支架内狭窄或闭塞。平均临床随访时间为 17.7 个月（范围，1-72 个月），1.4%的患者出现神经功能事件。对于椎动脉夹层，我们的综述共包括 8 项报告，涉及 10 例患者（12 支血管）。病因有创伤性（60%，n=6）、自发性（20%，n=2）和医源性（20%，n=2）。技术成功率为 100%。平均血管造影随访时间为 7.5 个月（范围，2-12 个月）。平均临床随访 26.4 个月（范围，3-55 个月）期间无新发神经功能事件。
颅外动脉夹层的血管内治疗仍在不断发展。目前的经验表明，这种治疗选择是安全和可行的。需要与药物治疗进行前瞻性随机试验，以进一步阐明支架置入的作用。
