Zhengxing Xie, Zhenwen Cui, Yuhao Sun, Zhihong Zhong, Liuguan Bian, Qingfang Sun
Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China.
Neurosurg Rev. 2016 Jul;39(3):393-9. doi: 10.1007/s10143-015-0689-0. Epub 2016 Feb 29.
Traumatic carotid artery dissection (tCAD) bears the risk of hypoperfusion inducing delayed cerebral ischemia. The lack of consensus on standard treatment of tCAD remains a great challenge. Here, we present our successes on a series of patients with delayed tCAD diagnosis and treatment using multimodality treatment strategies. We retrospectively reviewed 21 patients with tCAD treated with carotid artery stent placement or anticoagulation therapy. There were 14 dissection locations (66.67 %) which involved extracranial internal carotid artery (ICA) and seven locations (33.33 %) which involved both extracranial and intracranial ICA. Stenosis severity was 70-99 % in 16 cases (76.19 %) and <70 % in 5 cases (23.81 %). Endovascular stents were administrated to 17 patients with hypoperfusion as evaluated by radiological methods, while anticoagulation therapy was administrated to the other four patients. Carotid revascularization was performed with one (9/17 patients) or multiple (8/17 patients) stents. None of the patients experienced a procedure-related complication. At discharge, the mean modified Rankin Scale (mRS) score of patients was 1.08 ± 0.76. Neither additional neurological deficient nor restenosis happened during the follow-up period. More vigilance is required to assure timely diagnosis of patients with delayed tCAD. Assessment of cerebral perfusion is an effective approach in tCAD treatment in our experience.
创伤性颈动脉夹层（tCAD）存在低灌注诱发迟发性脑缺血的风险。对于tCAD的标准治疗缺乏共识仍然是一个巨大的挑战。在此，我们展示了我们在一系列采用多模式治疗策略对tCAD进行延迟诊断和治疗的患者中的成功经验。我们回顾性分析了21例接受颈动脉支架置入或抗凝治疗的tCAD患者。其中14个夹层部位（66.67%）累及颅外颈内动脉（ICA），7个部位（33.33%）累及颅外和颅内ICA。16例（76.19%）狭窄严重程度为70% - 99%，5例（23.81%）狭窄严重程度<70%。通过影像学方法评估，17例存在低灌注的患者接受了血管内支架治疗，另外4例患者接受了抗凝治疗。17例患者中，9例置入1枚支架，8例置入多枚支架进行颈动脉血运重建。所有患者均未发生与手术相关的并发症。出院时，患者的平均改良Rankin量表（mRS）评分为1.08±0.76。随访期间未出现额外的神经功能缺损或再狭窄。对于延迟性tCAD患者，需要更加警惕以确保及时诊断。根据我们的经验，评估脑灌注是tCAD治疗的一种有效方法。
