自发性颈动脉夹层相关缺血性卒中颅内缺血病灶分布特征与受累血管节段的关系研究

doi:10.3969/j.issn.1673-5765.2023.09.004

摘要/Abstract

摘要： 目的本研究自发性颈动脉夹层涉及自发性颈总动脉分叉夹层（spontaneous common carotid artery bifurcation dissection，sCCABD）及自发性颈内动脉夹层（spontaneous internal carotid artery dissection，sICAD），对与此相关的缺血性卒中颅内缺血病灶分布特征与受累血管节段间的关系进行分析。
方法本研究为单中心回顾性研究，连续入组2014年12月1日—2021年11月15日住院的sCCABD及sICAD相关缺血性卒中患者，收集患者一般临床资料、既往病史、影像学特征等信息。将患者分为颅内无梗死病灶组、单发梗死病灶组和多发梗死病灶组3组，比较不同组患者的影像学特征、受累血管部位及节段数等的差异。
结果研究纳入sCCABD及sICAD相关缺血性卒中患者17例，其中无梗死病灶组2例，单发梗死病灶组4例，多发梗死病灶组11例。无梗死病灶组夹层发生于C1升段（2例）、C2段（1例）、C3段（1例）、C4段（1例），单发梗死病灶组夹层在C1升段（5例）最多见，多发梗死病灶组夹层多发生于C1升段（5例）和C3段（5例），C2段（4例）、C1球部（3例）和C4段（3例）次之，颈总动脉分叉（1例）和C5段（1例）最少。脑梗死灶分布模式：单发梗死病灶组表现为区域性梗死（2例）、局部梗死（1例）、深部较大梗死
（1例）；多发梗死病灶组以内分水岭梗死（4例）、区域性梗死（3例）最多见，局部梗死（2例）、深部较大梗死（2例）次之，浅表小面积梗死（1例）、深部较小梗死（1例）最少。
结论本研究sCCABD及sICAD相关缺血性卒中患者以多发脑梗死居多，血管夹层多发生于C1升段和C3段，C1球部、C2段和C4段次之，颈总动脉分叉和C5段最少，球部可以受累或闭塞，颅内缺血病灶的多少与受累血管节段数量间的关系还不明确，还需进一步积累病例深入探讨。

文章导读： 本组自发性颈内动脉夹层病例以多发脑梗死居多，球部可以受累或闭塞，颈总动脉分叉处可以发生夹层，颅内缺血病灶的多少与受累血管节段数量间的关系有待进一步探讨。

关键词: 颈动脉夹层; 缺血性卒中; 脑梗死模式; 病因

Abstract: Objective The aim of the study is to investigate the relationship between the characteristics of ischemic infarction distribution and involved artery segments in patients with ischemic stroke caused by spontaneous carotid artery dissection. Spontaneous carotid artery dissection includes spontaneous common carotid artery bifurcation dissection (sCCABD) and spontaneous internal carotid artery dissection (sICAD).
Methods This was a single-center retrospective study. Patients hospitalized from December 1, 2014 to November 15, 2021 were continuously recruited. They were treated for ischemic stroke caused by spontaneous carotid artery dissection (sCCABD or sICAD or both). For each patient, the clinical data, medical history, imaging characteristics, and other relevant information were collected. Then they were divided into three groups as no cerebral infarction, single infarction, and multiple infarctions and compared by radiological findings, involved vascular location, and segments of arteries.
Results A total of 17 patients with ischemic stroke caused by spontaneous carotid artery dissection (sCCABD or sICAD or both) were included, including two patients with no infarction, four patients with a single infarction, and 11 patients with multiple infarctions. In the no infarction group, the arterial dissection location included C1 ascending (two cases), C2, C3, and C4 segments of the internal carotid artery (one case, respectively). Dissections were mainly found in the C1 ascending segment in the single infarction group (five cases). In the multiple infarctions group, arterial dissection occurred mostly in the C1 ascending and C3 segment (five cases, respectively), followed by the C2 (four cases), C1 bulbar (three cases), and C4 segment (three cases), and least in the common carotid artery bifurcation segment and C5 segment (one case, respectively). As for infarction location, territorial infarction (two cases), localized infarction (one case), and deep larger infarction (one case) were found in the single infarction group; internal watershed infarction (four cases), territorial infarction (three cases), localized infarction (two cases), deep larger infarction (two cases), small superficial (one case), and deep lacunar infarction (one case) were revealed in the multiple infarction group.
Conclusions In this study, multiple infarctions are more common in patients with ischemic stroke caused by spontaneous carotid artery dissection (sCCABD or sICAD or both). Dissection occurs mostly in C1 ascending and C3 segments of carotid artery, followed by the C1 bulbar, C2 and C4 segments, and rarely in the bifurcation of the common carotid artery and C5 segment of the internal carotid artery. Furthermore, the spontaneous dissection could occur in the carotid bulb and cause its occlusion. The relationship between the numbers of cerebral infarction and the involved dissected artery segments is to be explored by more cases in future.

Key words: Carotid artery dissection; Ischemic stroke; Cerebral infarction pattern; Etiology

吴敌, 荆京, 潘岳松, 陈绪珠, 赵性泉. 自发性颈动脉夹层相关缺血性卒中颅内缺血病灶分布特征与受累血管节段的关系研究[J]. 中国卒中杂志, 2023, 18(9): 993-1000.

WU Di, JING Jing, PAN Yuesong, CHEN Xuzhu, ZHAO Xingquan. Relationship between Characteristics of Ischemic Infarction Distribution and Involved Vascular Segments in Patients with Ischemic Stroke Caused by Spontaneous Carotid Artery Dissection[J]. Chinese Journal of Stroke, 2023, 18(9): 993-1000.

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