Patient presentation, angiographic features, and treatment of strangulation-induced bilateral dissection of the cervical internal carotid artery - Report of three cases
Patient presentation, angiographic features, and treatment of strangulation-induced bilateral dissection of the cervical internal carotid artery - Report of three cases
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DOI：
10.3171/jns.2000.92.3.0481
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发表时间：
2000-03-01
影响因子：
4.1
通讯作者：
Stoney, R
中科院分区：
文献类型：
--
作者：
Malek, AM;Higashida, RT;Stoney, R
家庭暴力导致施虐配偶勒颈，可能导致颈动脉夹层。这种现象很少见，之前仅在三个实例中描述过。作者在另外三个案例中提出了他们的处理策略。三名年龄在 24 岁到 43 岁之间的年轻女性在就诊前 3 个月到 1 年内被其配偶用手勒颈。其中两名患者在就诊前患有迟发性脑梗死，血管造影显示高颈内颈动脉（ICA）存在局灶性镜像严重残留狭窄，这是慢性夹层愈合的特征；没有纤维肌性发育不良的证据。其中一名患者接受了单侧经皮血管成形术并放置支架，另一名患者接受了双侧经皮血管成形术。两名患者均已从中风中康复，并分别在治疗后 8 个月和 20 个月时保持临床稳定。第三名患者因左侧 ICA 闭塞和右侧 ICA 严重狭窄而出现双侧额叶分水岭缺血性梗塞。考虑到已确定的梗死程度，该病例接受了长期抗凝药物治疗，但患者仍然存在神经功能障碍。这些病例说明手动压缩的 ICA 很容易因家庭暴力而遭受创伤性损伤。他们认为双侧对称 ICA 夹层是一致的发现，并且认为勒死导致迟发性中风的真正危险。使用经皮血管成形术和/或支架置入术的血管内治疗可用于治疗残留的局灶性狭窄，以改善脑灌注并降低栓塞或缺血性中风的风险。
Domestic violence leading to strangulation by an abusive spouse can cause carotid artery dissection. This phenomenon is rare and has been described in only three previous instances. The authors present their management strategies in three additional cases.Three young women aged 24 to 43 years were victims of manual strangulation committed by their spouses 3 months to 1 year before presentation. Two of the patients suffered delayed cerebral infarctions before presentation and angiography demonstrated focal, mirror-image severe residual stenoses in the high-cervical internal carotid artery (ICA), which were characteristic of a healed chronic dissection; there was no evidence of fibromuscular dysplasia. One of these patients underwent unilateral percutaneous angioplasty with stent placement, and the other underwent bilateral percutaneous angioplasty. Both patients have recovered from their strokes and remain clinically stable at 8 and 20 months posttreatment, respectively. The third patient presented with bilateral ischemic frontal watershed infarctions resulting from an occluded left ICA and a severely narrowed right ICA. Given the extent of the established infarctions, this case was managed with a long-term regimen of anticoagulation medications, and the patient remains neurologically impaired.These cases illustrate the susceptibility of the manually compressed ICA to traumatic injury as a result of domestic violence. They identify bilateral symmetrical ICA dissection as a consistent finding and the real danger of delayed stroke as a consequence of strangulation. Endovascular therapy in which percutaneous angioplasty and/or stent placement are used can be useful in treating residual Focal stenoses to improve cerebral perfusion and to lower the risk of embolic or ischemic stroke.