颈总动脉假性闭塞和假性夹层：伪装成颅外闭塞的颅内闭塞。
Cervical Carotid Pseudo-Occlusions and False Dissections: Intracranial Occlusions Masquerading as Extracranial Occlusions.
作者信息
Grossberg Jonathan A, Haussen Diogo C, Cardoso Fabricio B, Rebello Leticia C, Bouslama Mehdi, Anderson Aaron M, Frankel Michael R, Nogueira Raul G
机构信息
From the Department of Neurosurgery (J.A.G), and Department of Neurology (D.C.H., L.C.R., M.B., A.M.A., M.R.K., R.G.N.), Emory University/Grady Memorial Hospital, Atlanta, GA; and Department of Neurology, Universidade Estadual de Campinas, SP, Brasil (F.B.C).
出版信息
Stroke. 2017 Mar;48(3):774-777. doi: 10.1161/STROKEAHA.116.015427. Epub 2017 Jan 24.
BACKGROUND AND PURPOSE
Pseudo-occlusion (PO) of the cervical internal carotid artery (ICA) refers to an isolated occlusion of the intracranial ICA that appears as an extracranial ICA occlusion on computed tomography angiography (CTA) or digital subtraction angiography because of blockage of distal contrast penetration by a stagnant column of unopacified blood. We aim to better characterize this poorly recognized entity.
METHODS
Retrospective review of an endovascular database (2010-2015; n=898). Only patients with isolated intracranial ICA occlusions as confirmed by angiographic exploration were included. CTA and digital subtraction angiography images were categorized according to their apparent site of occlusion as (1) extracranial ICA PO or (2) discernible intracranial ICA occlusion.
RESULTS
Cervical ICA PO occurred in 21/46 (46%) patients on CTA (17 proximal cervical; 4 midcervical). Fifteen (71%) of these patients also had PO on digital subtraction angiography. A flame-shaped PO mimicking a carotid dissection was seen in 7 (33%) patients on CTA and in 6 (29%) patients on digital subtraction angiography. Patients with and without CTA PO had similar age (64.8±17.1 versus 60.2±15.7 years; =0.35), sex (male, 47% versus 52%; =1.00), and intravenous tissue-type plasminogen activator use (38% versus 40%; =1.00). The rates of modified Treatment In Cerebral Ischemia 2b-3 reperfusion were 71.4% in the PO versus 100% in the non-PO cohorts (<0.01). The rates of parenchymal hematoma, 90-day modified Rankin Scale score 0-2, and 90-day mortality were 4.8% versus 8% (=0.66), 40% versus 66.7% (=0.12), and 25% versus 21% (=0.77) in PO versus non-PO patients, respectively. Multivariate analysis indicated that PO patients had lower chances of modified Treatment In Cerebral Ischemia 3 reperfusion (odds ratio 0.14; 95% confidence interval 0.02-0.70; =0.01).
CONCLUSIONS
Cervical ICA PO is a relatively common entity and may be associated with decreased reperfusion rates.
背景与目的
颈内动脉假性闭塞（PO）是指颅内颈内动脉孤立性闭塞，在计算机断层扫描血管造影（CTA）或数字减影血管造影上表现为颅外颈内动脉闭塞，这是由于未显影的血液停滞柱阻塞了远端造影剂渗透所致。我们旨在更好地描述这一认识不足的实体。
方法
对一个血管内数据库（2010 - 2015年；n = 898）进行回顾性研究。仅纳入经血管造影探查证实为孤立性颅内颈内动脉闭塞的患者。CTA和数字减影血管造影图像根据其明显的闭塞部位分为（1）颅外颈内动脉PO或（2）可辨别的颅内颈内动脉闭塞。
结果
CTA上21/46（46%）例患者出现颈内动脉PO（17例为颈段近端；4例为颈段中段）。其中15例（71%）患者在数字减影血管造影上也有PO。7例（33%）患者在CTA上以及6例（29%）患者在数字减影血管造影上可见类似颈动脉夹层的火焰状PO。有CTA PO和无CTA PO的患者在年龄（64.8±17.1岁对60.2±15.7岁；P = 0.35）、性别（男性，47%对52%；P = 1.00）以及静脉使用组织型纤溶酶原激活剂方面（38%对40%；P = 1.00）相似。改良脑缺血治疗2b - 3级再灌注率在PO组为71.4%，在非PO组为100%（P<0.01）。PO组与非PO组患者的实质血肿发生率、90天改良Rankin量表评分0 - 2级以及90天死亡率分别为4.8%对8%（P = 0.66）、40%对66.7%（P = 0.12）和25%对21%（P = 0.77）。多因素分析表明，PO患者改良脑缺血治疗3级再灌注的机会较低（比值比0.14；95%置信区间0.02 - 0.70；P = 0.01）。
结论
颈内动脉PO是一种相对常见的情况，可能与再灌注率降低有关。
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