Cervicocranial Arterial Dissection: An Analysis of the Clinical Features, Prognosis, and Treatment Efficacy
Cervicocranial Arterial Dissection: An Analysis of the Clinical Features, Prognosis, and Treatment Efficacy
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颈颅动脉夹层：临床特征、预后和治疗效果分析
DOI：
10.2174/1567202611310020008
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发表时间：
2013-05-01
影响因子：
2.1
通讯作者：
Xu, Yun
中科院分区：
文献类型：
--
作者：
Jin, Jiali;Guan, Jingjing;Xu, Yun
颈颅动脉夹层（CCAD）的临床特点和治疗策略尚不清楚。对71例CCAD患者进行了回顾性分析。随访12个月，通过DSA确诊，并通过mRS评分评价疗效。所有患者根据临床情况分为3组：1）蛛网膜下腔出血（SAH）组，2）缺血症状组和3）占位效应组。CCAD合并前循环动脉夹层（ACAD）的缺血率高于后循环动脉夹层（PCAD）（p=0.023）。非动脉夹层（NAD）患者易发生缺血（p=0.00），动脉夹层（AD）患者更易发生SAH（p=0.001）; SAH患者的结局明显差于其他表现的患者（p=0.012）。随访1年，累及小脑后下动脉（PICA）的CCAD的结局明显差于其他区域（p=0.035）。1年随访时，血管内治疗与保守治疗之间的mRS评分无统计学显著差异（p=0.052）。接受血管内治疗的SAH患者的结局比接受保守治疗的患者改善（p=0.033）。ACAD、NAD和颅外CCAD组患者更易发生缺血，而AD组患者更易发生SAH。CCAD合并SAH或累及PICA者预后差。在随访12个月的CCAD患者中，保守治疗的疗效几乎等同于血管内治疗;然而，血管内治疗可降低SAH患者的死亡风险。
Clinical features and therapeutic strategies of cervicocranial arterial dissection (CCAD) are still unclear. A retrospective review was conducted on 71 CCAD patients. Diagnosed by DSA and outcome evaluation was through mRS scores follow-up 12 months. All patients were allocated into three groups according to clinical situation: 1) subarachnoid hemorrhage (SAH), 2) ischemic symptoms and 3) mass effect. CCAD with anterior circulation arterial dissection (ACAD) had higher ischemia than that with posterior circulation arterial dissection (PCAD) (p=0.023). The non-aneurysmal dissection (NAD) patients were susceptible to ischemia (p=0.00) and patients with aneurismal dissection (AD) were more susceptible to SAH (p=0.001); The outcome of patients with SAH was significantly worse than patients with other manifestations (p=0.012). Following up one year, the outcome of CCAD involving posterior inferior cerebellar artery (PICA) was significantly worse than the other area (p=0.035). There was no statistically significant difference in mRS scores between endovascular treatment and conservative treatment (p=0.052) at one year follow-up. Patients suffering from SAH that received endovascular treatment experienced improved outcomes than patients with conservative treatment (p=0.033). The patients in the ACAD, NAD and extracranial CCAD groups were more likely to suffer from ischemia, while patients in the AD group were susceptible to SAH. CCAD with SAH or involving PICA had poor prognoses. The therapeutic efficacy of conservative treatment is nearly equal to endovascular treatment in CCAD patients follow up 12 months; however, endovascular treatment may decrease the risk of mortality for the patient with SAH.