Engelter Stefan T, Traenka Christopher, Von Hessling Alexander, Lyrer Philippe A
Department of Neurology and Stroke Center, University Hospital Basel, Petersgraben 4, Basel CH - 4031, Switzerland; Neurorehabilitation Unit, Felix Platter Hospital, University Center for Medicine of Aging and Rehabilitation, Burgfelderstrasse 101, Basel CH - 4012, Switzerland.
Department of Neurology and Stroke Center, University Hospital Basel, Petersgraben 4, Basel CH - 4031, Switzerland.
Neurol Clin. 2015 May;33(2):421-41. doi: 10.1016/j.ncl.2014.12.002.
Cervical artery dissection (CAD) is a major cause of stroke in the young. A mural hematoma is detected in most CAD patients. The intramural blood accumulation should not be considered a reason to withhold intravenous thrombolysis in patients with CAD-related stroke. Because intravenous-thrombolyzed CAD patients might not recover as well as other stroke patients, acute endovascular treatment is an alternative. Regarding the choice of antithrombotic agents, this article discusses the findings of 4 meta-analyses across observational data, the current status of 3 randomized controlled trials, and arguments and counterarguments favoring anticoagulants over antiplatelets. Furthermore, the role of stenting and surgery is addressed.
颈动脉夹层（CAD）是年轻人中风的主要原因。大多数CAD患者可检测到壁间血肿。对于CAD相关中风患者，不应将壁内血液积聚视为拒绝静脉溶栓的理由。由于接受静脉溶栓的CAD患者可能不如其他中风患者恢复得好，急性血管内治疗是一种替代方案。关于抗血栓药物的选择，本文讨论了4项基于观察数据的荟萃分析结果、3项随机对照试验的现状，以及支持使用抗凝剂而非抗血小板药物的正反两方面观点。此外，还探讨了支架置入和手术的作用。
