Martinelli Ombretta, Venosi Salvatore, BenHamida Jamila, Malaj Alban, Belli Cristina, Irace Francesco Giosue', Gattuso Roberto, Frati Giacomo, Gossetti Bruno, Irace Luigi
Unit of Vascular Surgery, Department "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy.
Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy.
Ann Vasc Surg. 2017 May;41:69-76. doi: 10.1016/j.avsg.2016.07.087. Epub 2016 Dec 1.
The best management of carotid artery dissection (CAD) is still controversial ranging from antiplatelet medication to open surgery or endovascular treatment. In this retrospective study, we assessed the safety and efficacy of endovascular stent angioplasty for the treatment of CAD.
From February 2006 to February 2016, 44 patients (28 women and 16 men, age range 25-65 years, mean 42) with CAD were included in this study. The internal carotid artery dissection was spontaneous in 32 patients and posttraumatic in the remaining 12 (in 1 case, it was bilateral). Twenty-eight patients were treated by intravenous heparin infusion followed by standard oral anticoagulation. Carotid artery stenting was carried out in 14 cases with recurrent ischemic events despite optimal anticoagulation management. Two patients with an open trauma of the neck were submitted to a common carotid to internal carotid bypass (CC-CI bypass). The follow-up ranged from 6 to 60 months and was performed clinically first and with Doppler ultrasound and computed tomography or magnetic resonance at 6, 12, and 24 months.
Follow-up ranged from 6 to 60 months. Mortality was nil. All patients submitted to the endovascular or surgical management had an immediate relief of their neurologic symptoms with no procedure-related complications. No thrombosis or restenosis of the CC-CI bypass or of carotid artery stents occurred during intraoperative and postoperative period and follow-up.
An alternative therapeutic option is mandatory in a subset of patients regarded as being at high risk for stroke because anticoagulant therapy was either contraindicated or failed clinically with recurrent transient ischemic attacks/transient symptoms associated with brain infarction. In these selected cases, endovascular stent placement seems to be a safe and effective option to restore vessel lumen integrity and prevent stroke.
颈动脉夹层（CAD）的最佳治疗方法仍存在争议，范围涵盖抗血小板药物治疗、开放手术或血管内治疗。在这项回顾性研究中，我们评估了血管内支架血管成形术治疗CAD的安全性和有效性。
2006年2月至2016年2月，本研究纳入了44例CAD患者（28例女性和16例男性，年龄范围25 - 65岁，平均42岁）。32例患者的颈内动脉夹层为自发性，其余12例为创伤后夹层（其中1例为双侧）。28例患者接受静脉输注肝素，随后进行标准口服抗凝治疗。14例尽管接受了最佳抗凝治疗仍发生复发性缺血事件的患者接受了颈动脉支架置入术。2例颈部开放性创伤患者接受了颈总动脉至颈内动脉搭桥术（CC - CI搭桥术）。随访时间为6至60个月，首先进行临床随访，并在6、12和24个月时进行多普勒超声、计算机断层扫描或磁共振检查。
随访时间为6至60个月。无死亡病例。所有接受血管内或手术治疗的患者神经症状均立即缓解，无手术相关并发症。术中、术后及随访期间，CC - CI搭桥术或颈动脉支架均未发生血栓形成或再狭窄。
对于一部分被认为中风风险高的患者，由于抗凝治疗要么禁忌，要么在临床上因复发性短暂性脑缺血发作/与脑梗死相关的短暂症状而失败，必须有替代治疗选择。在这些选定的病例中，血管内支架置入似乎是恢复血管腔完整性和预防中风的安全有效选择。
