Arimura Koichi, Iihara Koji
Department of Neurosurgery, Kobe City Medical Center General Hospital.
Neurol Med Chir (Tokyo). 2016 Sep 15;56(9):517-23. doi: 10.2176/nmc.ra.2015-0312. Epub 2016 Apr 11.
Intracranial artery dissection (IAD) is a relatively rare cause of stroke, but it has been recognized increasingly with recent advances of the neuroimaging technique. Since rebleeding occurs frequently in the acute stage in the ruptured IAD, urgent surgical treatment should be performed to prevent rebleeding. On the other hand, surgical treatment for unruptured IAD is controversial because it has little risk for bleeding. However, surgical treatment for unruptured IAD may be considered if the formation or enlargement of the aneurysmal dilatation has been confirmed. Since there are several proposed surgical strategies for IAD, it is important to select an appropriate strategy on a case-by-case basis. If the risk of infarction due to vessel occlusion is high, combined bypass surgery should be considered.
颅内动脉夹层（IAD）是一种相对罕见的中风病因，但随着神经影像学技术的最新进展，其越来越多地被认识到。由于破裂性IAD在急性期经常发生再出血，应进行紧急手术治疗以防止再出血。另一方面，未破裂IAD的手术治疗存在争议，因为其出血风险较小。然而，如果已证实存在动脉瘤样扩张的形成或扩大，则可考虑对未破裂IAD进行手术治疗。由于针对IAD提出了几种手术策略，因此根据具体情况选择合适的策略很重要。如果因血管闭塞导致梗死的风险很高，则应考虑联合搭桥手术。
