颅内动脉夹层的发病机制、影像学特点和自然病程

doi:10.3969/j.issn.1673-5765.2020.10.007

摘要/Abstract

摘要：

颅内动脉夹层相比颅外动脉夹层较少见，且临床表现缺乏特异性，既可以表现为缺血性事件，也可以表现为出血性事件，多发生于年轻人。由于夹层发生部位、形成时机以及病变严重程度不同，临床表现各种各样，影像学对于确诊动脉夹层至关重要。颅内动脉夹层易复发，且死亡率较高，除无症状或症状轻微的患者给予保守治疗或随访观察外，对于症状较重或进展性动脉夹层患者，应给予积极治疗，包括血管内治疗。

文章导读： 本文总结了颅内动脉夹层的流行病学、发病机制、影像学特点和自然病程，颅内动脉夹层既可以出现缺血性事件，也可以出现出血性事件，HR-MRI血管壁成像和血管造影是确诊动脉夹层的重要手段。

关键词: 颅内动脉夹层; 发病机制; 影像学; 自然病程

Abstract:

Compared to extracranial artery dissection, intracranial artery dissection (IAD) is relatively uncommon, IAD clinical manifestations lack specificity, and it can present with either ischemic or hemorrhagic events. Artery dissection mostly occurs in young people. Due to the different location, formation timing and lesions severity, IAD clinical manifestations are various, and imaging is the key for the diagnosis of artery dissection. The recurrence rate and mortality of IAD are relatively high. IAD patients with no or mild symptoms can be given conservative treatment or follow-up observation, and patients with severe symptoms or progressive artery dissection should be given active treatment, including endovascular treatment.

Key words: Intracranial artery dissection; Pathogenesis; Imaging; Natural course

黎杰，贺雄军，黎凯锋，胡明，张亮，周宏星，王泽群，王一凡，刘亚杰. 颅内动脉夹层的发病机制、影像学特点和自然病程[J]. 中国卒中杂志, 2020, 15(10): 1067-1072.

LI Jie, HE Xiong-Jun,LI Kai-Feng, HU Ming, ZHANG Liang, ZHOU Hong-Xing, WANG Ze-Qun, WANG Yi-Fan, LIU Ya-Jie. Pathogenesis, Imaging Features and Natural Course of Intracranial Artery Dissection[J]. Chinese Journal of Stroke, 2020, 15(10): 1067-1072.

参考文献

[1] 陈红兵，李竹浩，洪华，等. 致缺血性卒中自发性脑

动脉夹层118例临床和影像学特征分析[J]. 中华内科

杂志，2016，55（5）：366-371.

[2] BILLER J，SACCO R L，ALBUQUERQUE F C，

et al. Cervical arterial dissections and association

with cervical manipulative therapy：a statement for

healthcare professionals from the American Heart

Association/American Stroke Association[J]. Stroke，

2014，45（10）：3155-3174.

[3] DEBETTE S，COMPTER A，LABEYRIE M A，et

al. Epidemiology，pathophysiology，diagnosis，and

management of intracranial artery dissection[J].

Lancet Neurol，2015，14（6）：640-654.

[4] SCHIEVINK W I. Spontaneous dissection of the

carotid and vertebral arteries[J]. N Engl J Med，2001，

344（12）：898-906.

[5] 夏程，陈会生. 颅内动脉夹层及其临床诊治现状[J].

中国实用内科杂志，2017，37（11）：995-998.

[6] HUANG Y C，CHEN Y F，WANG Y H，et al.

Cervicocranial arterial dissection：experience of 73

patients in a single center[J/OL]. Surg Neurol，2009，

72 Suppl 2：S20-S27；discussion S27[2020-05-21].

https：//doi.org/10.1016/j.surneu.2008.10.002.

[7] CAPLAN L R，BAQUIS G D，PESSIN M S，et al.

Dissection of the intracranial vertebral artery[J].

Neurology，1988，38（6）：868-868.

[8] CAPLAN L R，ESTOL C J，MASSARO A R.

Dissection of the posterior cerebral arteries[J]. Arch

Neurol，2005，62（7）：1138-1143.

[9] ALI M S，AMENTA P S，STARKE R M，et al.

Intracranial vertebral artery dissections：evolving

perspectives[J]. Interv Neuroradiol，2012，18（4）：

469-483.

[10] SHIN J H，SUH D C，CHOI C G，et al. Vertebral

artery dissection：spectrum of imaging findings with emphasis on angiography and correlation with

clinical presentation[J]. Radiographics，2000，20

（6）：1687-1696.

[11] FULLERTON H J，JOHNSTON S C，SMITH W

S. Arterial dissection and stroke in children[J].

Neurology，2001，57（7）：1155-1160.

[12] SCHIEVINK W I，MOKRI B，PIEPGRAS D G.

Spontaneous dissections of cervicocephalic arteries

in childhood and adolescence[J]. Neurology，1994，

44（9）：1607-1607.

[13] CHABRIER S，LASJAUNIAS P，HUSSON

B，et al. Ischaemic stroke from dissection of the

craniocervical arteries in childhood：report of 12

patients[J]. Eur J Paediatr Neurol，2003，7（1）：39-

42.

[14] RAFAY M F，ARMSTRONG D，DEVEBER

G，et al. Craniocervical arterial dissection in

children：clinical and radiographic presentation and

outcome[J]. J Child Neurol，2006，21（1）：8-16.

[15] BASSETTI C，CARRUZZO A，STURZENEGGER

M，et al. Recurrence of cervical artery dissection：a

prospective study of 81 patients[J]. Stroke，1996，27

（10）：1804-1807.

[16] GIROUD M，FAYOLLE H，ANDRE N，et al.

Incidence of internal carotid artery dissection in

the community of Dijon[J]. J Neurol Neurosurg

Psychiatry，1994，57（11）：1443.

[17] SCHIEVINK W I，MOKRI B，WHISNANT J P.

Internal carotid artery dissection in a community.

Rochester，Minnesota，1987-1992[J]. Stroke，1993，

24（11）：1678-1680.

[18] KIM B M，KIM S H，KIM D I，et al. Outcomes

and prognostic factors of intracranial unruptured

vertebrobasilar artery dissection[J]. Neurology，2011，

76（20）：1735-1741.

[19] KWAK J H，CHOI J W，PARK H J，et al.

Cerebral artery dissection：spectrum of clinical

presentations related to angiographic findings[J].

Neurointervention，2011，6（2）：78-83.

[20] ARAUZ A，RUIZ A，PACHECO G，et al. Aspirin

versus anticoagulation in intra- and extracranial

vertebral artery dissection[J]. Eur J Neurol，2013，20

（1）：167-172.

[21] VILELA P，GOULÃO A. Cervical and intracranial

arterial dissection：review of the acute clinical

presentation and imaging of 48 cases[J]. Acta Med

Port，2003，16（3）：155-164.

[22] ARNOLD M，BOUSSER M G，FAHRNI G，et

al. Vertebral artery dissection：presenting findings

and predictors of outcome[J]. Stroke，2006，37（10）：

2499-2503.

[23] ADAMS H P，ASCHENBRENER C A，KASSELL

N F，et al. Intracranial hemorrhage produced by

spontaneous dissecting intracranial aneurysm[J].

Arch Neurol，1982，39（12）：773-776.

[24] ENDO S，NISHIJIMA M，NOMURA H，et

al. A pathological study of intracranial posterior

circulation dissecting aneurysms with subarachnoid

hemorrhage：report of three autopsied cases and

review of the literature[J]. Neurosurgery，1993，33

（4）：732-738.

[25] FARRELL M A，GILBERT J J，KAUFMANN J

C. Fatal intracranial arterial dissection：clinical

pathological correlation[J]. J Neurol Neurosurg

Psychiatry，1985，48（2）：111-121.

[26] SAKATA N，TAKEBAYASHI S，KOJIMA M，et al.

Pathology of a dissecting intracranial aneurysm[J].

Neuropathology，2000，20（1）：104-108.

[27] YONAS H，AGAMANOLIS D，TAKAOKA Y，et al.

Dissecting intracranial aneurysms[J]. Surg Neurol，

1977，8（6）：407-415.

[28] VÖLKER W，DITTRICH R，GREWE S，et al. The

outer arterial wall layers are primarily affected in

spontaneous cervical artery dissection[J]. Neurology，

2011，76（17）：1463-1471.

[29] WONG L C Y，LANGILLE B L. Developmental

remodeling of the internal elastic lamina of rabbit

arteries：effect of blood flow[J]. Circ Res，1996，78

（5）：799-805.

[30] MIZUTANI T，MIKI Y，KOJIMA H，et al.

Proposed classification of nonatherosclerotic cerebral

fusiform and dissecting aneurysms[J]. Neurosurgery，

1999，45（2）：253-259.

[31] VRANIC J E，HUYNH T J，FATA P，et al. The

ability of magnetic resonance black blood vessel wall

imaging to evaluate blunt cerebrovascular injury

following acute trauma[J]. J Neuroradiol，2020，47

（3）：210-215.

[32] BAPST B，AMEGNIZIN J L，VIGNAUD A，et al.

Post-contrast 3D T1-weighted TSE MR sequences

（SPACE，CUBE，VISTA/BRAINVIEW，isoFSE，

3D MVOX）：technical aspects and clinical

applications[J]. J Neuroradiol，2020，47（5）：358-

368.

[33] 朱珠，韩翔，董强. 磁共振管壁成像在颅内动脉夹层

中的应用价值[J]. 中国卒中杂志，2017，12（6）：506-

511.

[34] BOND K M，KRINGS T，LANZINO G，et al.

Intracranial dissections：a pictorial review of

pathophysiology，imaging features，and natural

history[J/OL]. J Neuroradiol，2020[2020-05-20].

https：//doi.org/10.1016/j.neurad.2020.03.007.

[35] SANTOS-FRANCO J A，ZENTENO M，LEE A.

Dissecting aneurysms of the vertebrobasilar system.

A comprehensive review on natural history and

treatment options[J]. Neurosurg Rev，2008，31（2）：

131-140.

[36] RAMGREN B，CRONQVIST M，ROMNER B，et

al. Vertebrobasilar dissection with subarachnoid

hemorrhage：a retrospective study of 29 patients[J].

Neuroradiology，2005，47（2）：97-104.

[37] ONO H，NAKATOMI H，TSUTSUMI K，et al.

Symptomatic recurrence of intracranial arterial

dissections：follow-up study of 143 consecutive

cases and pathological investigation[J]. Stroke，2013，

44（1）：126-131.

[38] KAI Y，NISHI T，WATANABE M，et al. Strategy

for treating unruptured vertebral artery dissecting

aneurysms[J]. Neurosurgery，2011，69（5）：1085-

1092.

[39] MATSUKAWA H，SHINODA M，FUJII M，et al.

Basilar extension and posterior inferior cerebellar

artery involvement as risk factors for progression

of the unruptured spontaneous intradural vertebral

artery dissection[J]. J Neurol Neurosurg Psychiatry，

2014，85（9）：1049-1054.

[40] KOBAYASHI N，MURAYAMA Y，YUKI I，et

al. Natural course of dissecting vertebrobasilar

artery aneurysms without stroke[J]. AJNR Am J

Neuroradiol，2014，35（7）：1371-1375.

[41] SAKATA N，TAKEBAYASHI S，KOJIMA M，et al.

Pathology of a dissecting intracranial aneurysm[J].

Neuropathology，2000，20（1）：104-108.

[42] AHN S S，KIM B M，SUH S H，et al. Spontaneous

symptomatic intracranial vertebrobasilar dissection：

initial and follow-up imaging findings[J]. Radiology，

2012，264（1）：196-202.

[43] MIZUTANI T. Natural course of intracranial arterial

dissections[J]. J Neurosurg，2011，114（4）：1037-

1044.

[44] SCHIEVINK W I，MOKRI B，O'FALLON W M.

Recurrent spontaneous cervical-artery dissection[J].

N Engl J Med，1994，330（6）：393-397.