Reges Danyelle Sadala, Mazzeo Marcela, Rosalino Rafael, Gagliardi Vivian Dias Baptista, Cerqueira Leandro Gama, Gagliardi Rubens José
Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Medicina, Disciplina de Neurologia, São Paulo SP, Brasil.
Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo SP, Brasil.
Arq Neuropsiquiatr. 2019 Sep 23;77(9):632-637. doi: 10.1590/0004-282X20190108. eCollection 2019.
Cervical arterial dissection accounts for only a small proportion of ischemic stroke but arouses scientific interest due to its wide clinical variability. OBJECTIVE This study aimed to evaluate its risk factors, outline its clinical characteristics, compare treatment with antiaggregation or anticoagulation, and explore the prognosis of patients with cervical arterial dissection. METHODS An observational, retrospective study using data from medical records on patients with cervical arterial dissection between January 2010 and August 2015. RESULTS The total number of patients was 41. The patients' ages ranged from 19 to 75 years, with an average of 44.5 years. The most common risk factor was smoking. Antiaggregation was used in the majority of patients (65.5%); 43% of all patients recanalized in six months, more frequently in patients who had received anticoagulation (p = 0.04). CONCLUSION The presence of atherosclerotic disease is considered rare in patients with cervical arterial dissection; however, our study found a high frequency of hypertension, smoking and dyslipidemia. The choice of antithrombotic remains controversial and will depend on the judgment of the medical professional; the clinical results with anticoagulation or antiaggregation were similar but there was more recanalization in the group treated with anticoagulation; its course was favorable in both situations. The recurrence of cervical arterial dissection and stroke is considered a rare event and its course is favorable.
颈动脉硬化夹层仅占缺血性卒中的一小部分，但因其广泛的临床变异性而引起了科学关注。目的：本研究旨在评估其危险因素，概述其临床特征，比较抗血小板聚集或抗凝治疗方法，并探讨颈动脉硬化夹层患者的预后。方法：一项观察性回顾性研究，使用2010年1月至2015年8月期间颈动脉硬化夹层患者的病历数据。结果：患者总数为41例。患者年龄在19岁至75岁之间，平均年龄为44.5岁。最常见的危险因素是吸烟。大多数患者（65.5%）使用了抗血小板聚集治疗；所有患者中有43%在六个月内血管再通，接受抗凝治疗的患者再通更为频繁（p = 0.04）。结论：颈动脉硬化夹层患者中动脉粥样硬化疾病的存在被认为较为罕见；然而，我们的研究发现高血压、吸烟和血脂异常的发生率很高。抗血栓治疗的选择仍存在争议，将取决于医学专业人员的判断；抗凝或抗血小板聚集治疗的临床结果相似，但抗凝治疗组的血管再通更多；在两种情况下其病程均良好。颈动脉硬化夹层和卒中的复发被认为是罕见事件，且病程良好。
