颈动脉夹层影像学特点及预后分析

doi:10.3969/j.issn.1673-5765.2018.03.007

摘要/Abstract

摘要：

目的探讨颈动脉夹层所致缺血性卒中患者的影像学特点，通过超声随访分析影响此类患者预后的因素。方法连续收集因颈动脉夹层导致的急性缺血性卒中或短暂性脑缺血发作（transient ischemic attack， TIA）住院患者的临床资料，分别在入组3、6个月时对患者进行随访，6个月时采用改良Rankin量表评分（modified Rankin scale，mRS）评估预后。结果共纳入42例颈动脉夹层所致缺血性卒中或TIA的患者，其中颈内动脉夹层35例（83%），椎动脉夹层7例（17%）。颈部血管超声确诊了全部27例（64%）最终经计算机断层扫描血管造影（computed tomography angiography，CTA）或数字减影血管造影（digital subraction angiography，DSA）证实的颈部血管闭塞患者。CTA影像学表现中以血管闭塞时“双腔征”最常见（26例，63%），其次为“火焰征”（7 例，17%）。预后良好组和预后不良组间血管再通等因素的比例无显著差异，预后不良组一侧肢体无力（92.3% vs 45.8%）、基底节受累（69.2% vs 25%）、颈动脉夹层比例（100% vs 70.8%）高于预后良好组，差异有统计学意义。结论颈动脉夹层预后与肢体功能障碍、脑梗死的位置、夹层的分型相关，而与血管再通率无关。

文章导读： 通过对颈动脉夹层所致缺血性卒中患者的影像学资料分析显示，超声对颈动脉夹层所致动脉狭窄诊断较准确，此类患者的一年预后与肢体功能障碍、脑梗死的位置、夹层的分型相关。

关键词: 颈动脉夹层; 颈部血管超声; 临床特点; 再通; 预后

Abstract:

Objective To explore the imaging feature of cervical artery dissection (CAD), and analyze the influential factors of prognostic assessed by ultrasound follow-up. Methods From June 2013 to October 2015, inpatients with acute stroke or transient ischemic attack (TIA) following vascular occlusion or stenosis due to CAD admitted to department of neurology, first hospital of Shanxi medical university were consecutively enrolled. All the patients were evaluated by neurovascular ultrasound at 3rd and 6th month respectively after discharge. At 6th month, neurological deficits were assessed using the modified Rankin Scale (mRS). Results Among 42 patients with CAD, 35 cases (83%) were internal carotid artery dissection and the rest of 7 cases (17%) were vertebral artery dissection. 27 cervical artery occlusion cases (64%) were diagnosed by ultrasound, which were all finally confirmed by computed tomography angiography (CTA) or digital subtraction angiography (DSA). The most typical sign of vascular imaging for the cervical artery occlusion was the "dual-chamber sign" (26,63%), followed by "flame sign" (7,17%). There was no significant difference in the proportion of vascular recanalization between good prognosis group and poor prognosis group. The proportion of limb weakness (92.3% vs 45.8%), basal ganglia involvement (69.2% vs 25%) and vertebral artery dissection (100% vs 70.8%) in poor prognosis group were all higher than that in good prognosis group, and the difference was statistically significant.

Conclusion The prognosis of cerebral artery dissection is related to limb dysfunction, the position of cerebral infarction, and the type of dissection, but not the recanalization rate.

Key words: Cervical artery dissection; Neurovascular ultrasound; Clinical characteristics;Recanalization; Prognosis

房亚兰, 常俊森, 牛小媛. 颈动脉夹层影像学特点及预后分析[J]. 中国卒中杂志, 2018, 13(03): 232-236.

FANG Ya-Lan, CHANG Jun-Sen, NIU Xiao-Yuan. Cervical Artery Dissection: Imaging Feature and Prognostic Analysis[J]. Chinese Journal of Stroke, 2018, 13(03): 232-236.

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