颈动脉夹层的长期预后。

Long-term outcome of cervical artery dissection.

机构信息

Department of Vascular Surgery, University Hospital Limerick, University of Limerick, Limerick, Ireland; Department of Radiology, University Hospital Limerick, University of Limerick, Limerick, Ireland.

出版信息

J Vasc Surg. 2023 Jul;78(1):158-165. doi: 10.1016/j.jvs.2023.03.020. Epub 2023 Mar 12.

DOI:10.1016/j.jvs.2023.03.020

PMID:36918105

Abstract

OBJECTIVE

The aim of the study is to evaluate the natural history of extracranial cervical artery dissection (CAD) including comorbidities, symptoms at presentation, recurrence of symptoms, and long-term outcome following different treatment approaches.

METHODS

A retrospective review of patients treated for acute CAD was performed over a 5-year period from January 2017 to April 2022.

RESULTS

Thirty-nine patients were included in the study, 25 (64.1%) with acute internal carotid artery dissection and 14 (35.9%) with acute vertebral artery dissection. Thirty-four patients (87.1%) had spontaneous CAD, and five patients (12.8%) had traumatic CAD. The mean age of the cohort was 54.2 years. The mean time from symptom onset to presentation was 4.34 days. The most common symptoms in internal carotid artery dissection were unilateral weakness (44%), headache (44%), slurred speech (36%), facial droop (28%), unilateral paraesthesia (24%), neck pain (12%), visual disturbance (8%), and Horner's syndrome (8%). The most common symptoms in vertebral artery dissection were headache (35.7%), neck pain (35.7%), vertigo (28.57%), ataxia (14.28%), and slurred speech (14.28%). The imaging modalities used for diagnosis included computed tomography angiography (48.7%), magnetic resonance angiography (41%), and duplex ultrasound (10.2%). In patients with carotid artery dissection, 57% had severe stenosis, 24% had moderate stenosis, and 20% had mild stenosis. All patients treated were managed conservatively with either anticoagulation or antiplatelets. Long-term clinical follow-up was available for 33 patients (84.6%). Thirty patients (90.9%) reported complete resolution of symptoms, and three patients (9%) reported persistent symptoms. Anatomic follow-up with imaging was available for 17 patients (43.58%). Thirteen patients (76.47%) had complete resolution of dissection, two patients (11.76%) had partial resolution of dissection, and two patients (11.76%) had persistent dissection. There was one death unrelated to CAD in a multi-trauma patient. There were four early recurrent symptoms in the first 3 to 8 weeks post discharge. The mean follow-up time was 308.27 days.

CONCLUSIONS

The majority of CADs can be managed conservatively with good clinical and anatomical outcome and low rates of recurrence.

摘要

目的

本研究旨在评估颅外颈内动脉夹层（CAD）的自然病程，包括合并症、发病时的症状、症状复发以及不同治疗方法的长期预后。

方法

回顾性分析了 2017 年 1 月至 2022 年 4 月期间接受急性 CAD 治疗的患者。

结果

本研究共纳入 39 例患者，25 例（64.1%）为急性颈内动脉夹层，14 例（35.9%）为急性椎动脉夹层。34 例（87.1%）为自发性 CAD，5 例（12.8%）为外伤性 CAD。队列的平均年龄为 54.2 岁。从症状发作到就诊的平均时间为 4.34 天。颈内动脉夹层最常见的症状为单侧无力（44%）、头痛（44%）、言语不清（36%）、面瘫（28%）、单侧感觉异常（24%）、颈痛（12%）、视力障碍（8%）和霍纳氏综合征（8%）。椎动脉夹层最常见的症状为头痛（35.7%）、颈痛（35.7%）、眩晕（28.57%）、共济失调（14.28%）和言语不清（14.28%）。用于诊断的影像学方法包括计算机断层血管造影（48.7%）、磁共振血管造影（41%）和双功超声（10.2%）。在颈动脉夹层患者中，57%有严重狭窄，24%有中度狭窄，20%有轻度狭窄。所有接受治疗的患者均接受抗凝或抗血小板治疗。33 例（84.6%）患者进行了长期临床随访。30 例（90.9%）患者症状完全缓解，3 例（9%）患者症状持续存在。17 例（43.58%）患者进行了影像学解剖随访。13 例（76.47%）患者夹层完全愈合，2 例（11.76%）患者夹层部分愈合，2 例（11.76%）患者夹层持续存在。1 例多创伤患者因与 CAD 无关的死亡。出院后 3 至 8 周内有 4 例早期复发症状。平均随访时间为 308.27 天。