Daou Badih, Hammer Christine, Mouchtouris Nikolaos, Starke Robert M, Koduri Sravanthi, Yang Steven, Jabbour Pascal, Rosenwasser Robert, Tjoumakaris Stavropoula
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
Department of Emergency Surgery, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.
Neurosurgery. 2017 Mar 1;80(3):368-379. doi: 10.1093/neuros/nyw086.
Dissection of the carotid and vertebral arteries is an important cause of stroke in young patients.
The objective of this study is to compare antithrombotic treatments in patients with carotid and vertebral dissections.
Three hundred seventy patients with carotid and vertebral artery dissections were included. Univariate and multivariate analyses were conducted to analyze the association between treatment and new or recurrent events and clinical outcome.
Mean follow-up was 24.3 months. In patients with spontaneous dissection, 55% received antiplatelets, 29.4% anticoagulation, and 12.6% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 9.6% of patients on antiplatelets, 10.4% on anticoagulation, and 13.3% on combined treatment. For traumatic dissection, 58.3% received antiplatelets, 26.9% anticoagulation, and 10.2% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 6.9% on antiplatelets, 11.1% on anticoagulation, and 20% on combined treatment. In patients with intracranial dissection, 63.1% were started on antiplatelets, 19.7% on anticoagulation, and 14.5% on combined treatment. Ischemic and hemorrhagic events occurred in 8.5% on antiplatelet treatment, 15.4% on anticoagulation, and 18.2% on combined treatment. In patients with extracranial dissection, 54.4% were on antiplatelets, 28.9% on anticoagulation, and 11.2% on combined treatment. Ischemic and hemorrhagic events occurred in 10.1% on antiplatelet treatment, 9.3% on anticoagulation, and 13.8% on combined treatment. The association between antithrombotic treatment and ischemic/hemorrhagic events and clinical outcome was not significant for all subtypes of dissection.
The rate of new or recurrent events is similar with antiplatelet and anticoagulation treatment in treating intracranial and extracranial carotid and vertebral artery dissection.
颈动脉和椎动脉夹层是年轻患者中风的重要原因。
本研究的目的是比较颈动脉和椎动脉夹层患者的抗栓治疗。
纳入370例颈动脉和椎动脉夹层患者。进行单因素和多因素分析以分析治疗与新的或复发性事件及临床结局之间的关联。
平均随访24.3个月。在自发性夹层患者中，55%接受抗血小板治疗，29.4%接受抗凝治疗，12.6%接受联合治疗。接受抗血小板治疗的患者中9.6%发生新的或复发性缺血性和出血性事件，接受抗凝治疗的患者中10.4%发生此类事件，接受联合治疗的患者中13.3%发生此类事件。对于创伤性夹层，58.3%接受抗血小板治疗，26.9%接受抗凝治疗，10.2%接受联合治疗。接受抗血小板治疗的患者中6.9%发生新的或复发性缺血性和出血性事件，接受抗凝治疗的患者中11.1%发生此类事件，接受联合治疗的患者中20%发生此类事件。在颅内夹层患者中，63.1%开始接受抗血小板治疗，19.7%接受抗凝治疗，14.5%接受联合治疗。抗血小板治疗的患者中8.5%发生缺血性和出血性事件，抗凝治疗的患者中15.4%发生此类事件，联合治疗的患者中18.2%发生此类事件。在颅外夹层患者中，54.4%接受抗血小板治疗，28.9%接受抗凝治疗，11.2%接受联合治疗。抗血小板治疗的患者中10.1%发生缺血性和出血性事件，抗凝治疗的患者中9.3%发生此类事件，联合治疗的患者中13.8%发生此类事件。对于所有夹层亚型，抗栓治疗与缺血性/出血性事件及临床结局之间的关联均不显著。
在治疗颅内和颅外颈动脉及椎动脉夹层时，抗血小板治疗和抗凝治疗的新的或复发性事件发生率相似。
