McGuire Laura Stone, Kumar Prateek, Ryoo James S, Alaraj Ali
Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
Department of Neurology, University of Illinois at Chicago, Chicago, IL, USA.
Interv Neuroradiol. 2024 Feb;30(1):64-71. doi: 10.1177/15910199221106040. Epub 2022 Jun 3.
The role of endovascular treatment in cervical artery dissection (CAD) is equivocal. This study compared cerebral blood flow in CAD between medically and endovascularly treated patients using quantitative magnetic resonance angiography (QMRA).
Retrospective chart review was completed for patients with CAD. Inclusion criteria were adults (>18 years) with diagnosis of dissection of the internal carotid artery or vertebral artery who received QMRA. The cases were reviewed for clinical presentation, diagnosis, management, and imaging, and in particular, patients who underwent endovascular treatment were evaluated.
Forty-one patients were included, 46.3% female and mean age 46.0+/- 11.9 years. 21 patients (51.2%) had contralateral (ICA) dissections while 19 (46.3%) had vertebral artery (VA) dissections, and 1 had both involved. Five patients underwent stenting, angioplasty, or both. Baseline characteristics between patients who underwent medical versus endovascular treatment were similar, although patients undergoing stenting/angioplasty were more likely to have diabetes (p = 0.015) and prior anticoagulation use (p = 0.007). All endovascular patients demonstrated ischemia on MRI versus 53.1% of those undergoing medical management (p = 0.047). Comparing ipsilateral vessel flow over time in these two patient groups showed those who underwent stenting or angioplasty had lower baseline flows, albeit non-significant (p = 0.629). Patients who underwent endovascular treatment had lower distal flow compared to the medical management group.
This study represents the first to assess vessel flow using QMRA in patients who underwent endovascular treatment of CAD. In combination with progressive symptoms, QMRA may serve as a useful adjunct in the selection of patients for endovascular intervention in arterial dissections.
血管内治疗在颈动脉夹层（CAD）中的作用尚不明确。本研究使用定量磁共振血管造影（QMRA）比较了接受药物治疗和血管内治疗的CAD患者的脑血流量。
对CAD患者进行回顾性病历审查。纳入标准为诊断为颈内动脉或椎动脉夹层且接受QMRA的成年人（>18岁）。对病例进行临床表现、诊断、治疗和影像学审查，尤其对接受血管内治疗的患者进行评估。
纳入41例患者，女性占46.3%，平均年龄46.0±11.9岁。21例患者（51.2%）有对侧（ICA）夹层，19例（46.3%）有椎动脉（VA）夹层，1例两者均有。5例患者接受了支架置入术、血管成形术或两者皆有。接受药物治疗与血管内治疗的患者基线特征相似，不过接受支架置入术/血管成形术的患者更可能患有糖尿病（p = 0.015）和曾使用抗凝剂（p = 0.007）。所有血管内治疗患者的MRI显示有缺血，而接受药物治疗的患者中这一比例为53.1%（p = 0.047）。比较这两组患者同侧血管随时间的血流情况，发现接受支架置入术或血管成形术的患者基线血流较低，尽管无统计学意义（p = 0.629）。与药物治疗组相比，接受血管内治疗的患者远端血流较低。
本研究是首次使用QMRA评估接受CAD血管内治疗患者的血管血流。结合进行性症状，QMRA可能在选择动脉夹层血管内干预患者时作为有用的辅助手段。
