Identification of Internal Carotid Artery Dissection by Transoral Carotid Ultrasonography
Identification of Internal Carotid Artery Dissection by Transoral Carotid Ultrasonography
复制标题
经口颈动脉超声检查识别颈内动脉夹层
DOI：
10.1159/000336121
复制
发表时间：
2012
影响因子：
2.9
通讯作者：
K. Minematsu
中科院分区：
文献类型：
--
作者：
Rieko Suzuki;M. Koga;K. Toyoda;M. Uemura;Hikaru Nagasawa;Y. Yakushiji;H. Moriwaki;N. Yamada;K. Minematsu
背景和目的：传统的经颈表面颈动脉超声检查(TSCU)往往无法发现颈内动脉(ICA)颅外段夹层。探讨经口颈动脉超声(TOCU)在颈内动脉夹层诊断中的作用。方法：回顾分析本组缺血性卒中或短暂性脑缺血发作(TIA)患者数据库中经数字减影血管造影(DSA)证实的单侧ICA夹层。对TSCU和TOCU的解剖结果进行比较。结果：8例患者(男性7例，年龄37~69岁)，其中7例为缺血性中风，1例为短暂性脑缺血发作，均行颈内动脉夹层。DSA显示4例患者第一、第三椎体之间夹层，其余4例从第三颈椎至颅内水平夹层。TOCU图像显示内膜瓣是所有患者夹层的确切证据。7例假腔内未见彩色血流信号，提示有血栓形成。4例患者在TOCU随访中显示夹层形态改变，包括1例假腔内彩色血流信号恢复。分离的颈内动脉直径为(7.3±0.7)mm，对侧颈内动脉直径为(4.9±0.6)mm(p=0.008)。相比之下，TSCU没有使任何患者的颈内动脉解剖有任何确凿的发现。6例在T1加权MRI上有壁内血肿，2例在磁共振血管成像上有双腔内膜瓣。结论：TOCU在颈内动脉夹层的准确诊断和随访评价方面优于TSCU。
Background and Purpose: Conventional transsurface carotid ultrasonography (TSCU) via the cervical surface often fails to detect dissection of the extracranial internal carotid artery (ICA). The role of transoral carotid ultrasonography (TOCU) in the detection of ICA dissection was examined. Method: Patients with unilateral extracranial ICA dissection identified by digital subtraction angiography (DSA) from our database of patients with ischemic stroke or transient ischemic attack (TIA) were reviewed. Findings of dissection were compared between TSCU and TOCU. Results: Eight patients (7 men, 37–69 years old), including 7 with ischemic stroke and 1 with TIA, had ICA dissection. By DSA, dissection was identified between the first and third vertebrae in 4 patients and from the third cervical vertebra to the intracranial level in the remaining 4. TOCU images revealed an intimal flap as definite evidence of dissection in all patients. In 7 patients, color flow signals were not seen in false lumens, indicating thrombosed lumens. Four patients showed morphological changes of dissection on follow-up TOCU, including a patient with recovery of color flow signals in false lumens. The diameter of the dissected ICA was 7.3 ± 0.7 mm and that of the contralateral ICA was 4.9 ± 0.6 mm (p = 0.008). In contrast, TSCU did not enable any conclusive findings of ICA dissection to be made in any patient. Six patients had intramural hematoma on T1-weighted MRI, and 2 had an intimal flap with a double lumen on magnetic resonance angiography. Conclusion: TOCU has advantages over TSCU in achieving an accurate diagnosis and follow-up evaluation of ICA dissection.