Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA.
Int J Neurosci. 2012 Jan;122(1):40-4. doi: 10.3109/00207454.2011.622453. Epub 2011 Oct 13.
Cervical artery dissection (CAD) is a common cause of stroke in young individuals. Risk factors, treatment, and outcome of CAD are not well established. Our aim is to identify risk factors, outcome, and discuss treatment of CAD.
We reviewed medical records of patients seen at our institution between 2004 and 2009, using ICD-9 codes for CAD, for risk factors, treatment, type, and outcome. Poor outcome was defined as modified Rankin Scale (mRS) score within 6 months of >1 or recurrent stroke or transient ischemic attack (TIA).
A total of 47 patients were identified. Twenty-four patients had spontaneous dissections (52%); 30 (63%) involved the carotid. As compared with spontaneous dissections, traumatic dissections occurred in younger patients (mean age 41.0 vs. 47.7 years, p = .064), were more likely to involve the vertebral artery (52% vs. 21%, p = .036, and caused less neurological deficits on presentation (48% vs. 75%, p = .075). Conversely, spontaneous dissections were more likely to occur in patients with hypertension (63% vs. 30%, p = .041) and hypercholesterolemia (46% vs. 9%, p = .008). Patients having no stroke had better outcomes (100% vs. 54%, p < .001). Anticoagulation was used in 17 patients (36%) and antiplatelets in 31 (64%). Outcome and adverse events were similar in the two groups.
Hypertension and hypercholesterolemia were risk factors in spontaneous dissections, speaking for vascular wall abnormalities as potential contributors to pathophysiology of CAD. There was no evidence supporting one type of treatment over the other. A large ongoing prospective study should quell this controversy.
颈内动脉夹层（CAD）是年轻人中风的常见原因。CAD 的风险因素、治疗和预后尚不清楚。我们的目的是确定 CAD 的风险因素、预后，并讨论治疗方法。
我们使用 ICD-9 代码对 2004 年至 2009 年间在我院就诊的患者进行了病历回顾，以确定 CAD 的风险因素、治疗、类型和预后。预后不良定义为改良 Rankin 量表（mRS）评分在 6 个月内>1 或复发中风或短暂性脑缺血发作（TIA）。
共确定了 47 例患者。24 例为自发性夹层（52%）；30 例（63%）涉及颈动脉。与自发性夹层相比，外伤性夹层发生在更年轻的患者（平均年龄 41.0 岁 vs. 47.7 岁，p =.064），更可能涉及椎动脉（52% vs. 21%，p =.036），并且在发病时神经系统缺损较轻（48% vs. 75%，p =.075）。相反，自发性夹层更可能发生在高血压患者（63% vs. 30%，p =.041）和高胆固醇血症患者（46% vs. 9%，p =.008）中。没有发生中风的患者预后更好（100% vs. 54%，p <.001）。17 例（36%）患者使用抗凝药物，31 例（64%）患者使用抗血小板药物。两组的预后和不良事件相似。
高血压和高胆固醇血症是自发性夹层的危险因素，提示血管壁异常可能是 CAD 病理生理学的潜在原因。没有证据支持一种治疗方法优于另一种。一项正在进行的大型前瞻性研究应该能够平息这一争议。
