Salehi Omran Setareh
Continuum (Minneap Minn). 2023 Apr 1;29(2):540-565. doi: 10.1212/CON.0000000000001233.
Cervical artery dissection is a common cause of stroke in young adults. This article reviews the pathophysiology, etiology and risk factors, evaluation, management, and outcomes of spontaneous cervical artery dissection.
Cervical artery dissection is believed to be a multifactorial disease, with environmental factors serving as possible triggers in patients who have a genetic predisposition to dissection formation. Cervical artery dissection can cause local symptoms or ischemic events, such as ischemic stroke or transient ischemic attack. Neuroimaging is used to confirm the diagnosis; classic findings include a long tapered arterial stenosis or occlusion, dissecting aneurysm, intimal flap, double lumen, or intramural hematoma. Patients with cervical artery dissection who present with an acute ischemic stroke should be evaluated for IV thrombolysis, endovascular therapy eligibility, or both. Antithrombotic therapy with either anticoagulation or antiplatelet treatment is used to prevent stroke from cervical artery dissection. The risk of recurrent ischemia appears low and is mostly limited to the first two weeks after symptom onset.
Cervical artery dissection is a known cause of ischemic strokes. Current data show no difference between the benefits and risks of anticoagulation versus antiplatelet therapy in the acute phase of symptomatic extracranial cervical artery dissection, thereby supporting the recommendation that clinicians can prescribe either treatment. Further research is warranted to better understand the pathophysiology and long-term outcomes of cervical artery dissection.
颈内动脉夹层是年轻成年人中风的常见原因。本文综述了自发性颈内动脉夹层的病理生理学、病因及危险因素、评估、治疗及预后。
颈内动脉夹层被认为是一种多因素疾病，环境因素可能是在具有夹层形成遗传易感性的患者中引发疾病的原因。颈内动脉夹层可导致局部症状或缺血性事件，如缺血性中风或短暂性脑缺血发作。神经影像学用于确诊；典型表现包括长段逐渐变细的动脉狭窄或闭塞、夹层动脉瘤、内膜瓣、双腔或壁内血肿。出现急性缺血性中风的颈内动脉夹层患者应评估是否适合静脉溶栓、血管内治疗或两者皆适合。使用抗凝或抗血小板治疗的抗血栓治疗用于预防颈内动脉夹层导致的中风。复发性缺血的风险似乎较低，且大多限于症状发作后的前两周。
颈内动脉夹层是缺血性中风的已知病因。目前的数据表明，在有症状的颅外颈内动脉夹层急性期，抗凝治疗与抗血小板治疗的获益和风险之间没有差异，从而支持临床医生可开具任何一种治疗方法的建议。有必要进行进一步研究，以更好地了解颈内动脉夹层的病理生理学和长期预后。
