48例颈动脉闭塞患者诊治体会

48例颈动脉闭塞患者诊治体会
赵守财;杨倩;储照虎;吴雪松;倪进军;薛莲;周志明
【期刊名称】《皖南医学院学报》
【年(卷),期】2013(32)4
【摘要】Objective:To investigate the significance of selecting different management strategy for the patients with internal carotid artery occlusion (ICAO) by the clinical presentation of the occluded artery and the com-pensation modus of aortocranial artery under digital substraction angiogra-phy(DSA).Methods:Forty-eight patients were included with unilateral ICAO confirmed by cranial MRA between Aug.2008 and
Jan.2013,and underwent different management in compliance with artery picture and compensation modus of cerebral artery of DSA .Results:The symptoms of ICAO were primarily characterized by hemiparalysis , aphasia and dysar-thria,syncope,dizzy and seizure.DSA for the aortocranial artery revealed occlusion at the initial part of common carotid artery in 2
cases(4.2%), innominate artery in 1(2.1%),internal carotid artery in
45(93.8%) in whom 9(20.0%) were presented with slow-moving forward blood flow, 34 ( 75.6%) with extracranial carotid arterial stenostic disease, 11 (24.4%) with intracranial carotid arterial stenosis,8(16.7%) with se-vere concomitance stenosis of contralateral internal carotid artery , 5(10.4%) with concomitant involvement of vertebral artery stenosis and 2(4.2%)with concomitance of middle cerebral artery stenosis.On exami-nation of the
compensatory ways of collateral circulation at the intracrinal-ly occluded artery,18(37.5%) cases were compensated by contrallateral internal carotid artery via anterior communicating artery(ACoA),4(8. 3%) via ipsilateral posterior communicating artery(PCoA),5(10.4%) through both ACoA and PCoA and another 5(10.4%) via ACoA and ex-ternal carotid artery branches by primary compensation ,whereas 11 cases (22.9%) merely by meningeal arteries,2(5.2%) via both external ca-rotid and pial arteries and another
2(52%) through posterior communica-ting artery and pia mater by secondary compensation.By medication,con-tralateral transient ischemic attack ( TIA ) or minor stroke occurred in 5 cases in one month of therapy,aggravated contralateral hemiplegic limbsin 3,ipsolateral infract in 2 by follow-up in 6 months,minor stroke or repeatedseizure attack in 5.By cerebral stent implantation,minor stroke occurredin only 1 case in one month and aggravated hemiplegia in another1.Six-month follow-up showed no attack of TIA or cerebral infarction.Twocases undergone anticoagulant therapy had arterial recanalization in twomonthfollow-up by DSA detection,with only rough vascular walls or beadlikechanges appeared at segment of C1,yet no significant stenosis.Conclusion:Patients with ICAO may benefit a lot from individualized therapyby evaluation of the status of cranial artery and collateral circulation onDSA basis.% 目的：分析颈动脉闭塞（ internal carotid artery occlu-sion，ICAO）患者的临床症状及DSA （digital substraction angi-ography，DSA）全脑血管造影特点以及代偿方式，观察根据其特点对患者选择不同治疗方法的指导意义。

方法：2008年8月～2013年1月，收治症状性ICAO患者48例，均由头颅MRA确诊，均行全脑血
管造影术，根据其血管特点决定不同的治疗手段，并进行随访。

结果：ICAO的症状主要为偏瘫，语言功能障碍，晕厥，头晕，癫痫发作等；DSA血管造影术显示：颈总动脉起始部闭塞2例（4．2％）；无名动脉闭塞1例（2．1％）；颈内动脉全程闭塞45例（93．8％），其中有缓慢前向血流者9例（20．0％）。

颈内动
脉颅外段闭塞34例（75．6％）；颈内动脉颅内段闭塞11例（24．4％）。

合并对侧颈动脉重度狭窄者8例（16．7％）；合并椎动脉狭窄者5例（10．4％），合并对侧大脑中动脉狭窄者2例（4．2％）。

闭塞侧颅内侧枝循环代偿情况：初
级代偿：单独具有前交通动脉代偿者18例（37．5％）；单独具有后交通动脉代
偿者4例（8．3％）；同时具有前交通动脉及后交通动脉代偿者5例（10．4％）；同时具有前交通动脉及颈外动脉分支代偿者5例（10．4％）。

次级代偿：仅软脑膜代偿11例（22．9％）；颈外动脉及软脑膜动脉2例（5．2％）；后交通动脉及软脑膜2例（5．2％）。

药物治疗者1月内有5例仍发作对侧TIA或小中风；3例发生病灶对侧肢体偏瘫加重；随访6月发生同侧梗死2例；小中风或癫痫反复发作者5例。

支架置入术者1月内有1例发生小中风；1例偏瘫加重；随访6月均未发作TIA或脑梗死。

抗凝治疗2例，随访2月，复查
造影时闭塞颈内动脉完全再通，仅C1段血管壁毛糙或串珠样改变，无明显狭窄。

结论：通过全脑动脉造影评估ICAO患者的侧枝循环及全脑血管整体情况，从而决定不同的治疗策略，可使患者得到最大的收益。

【总页数】4页(P287-290)
【作者】赵守财;杨倩;储照虎;吴雪松;倪进军;薛莲;周志明
【作者单位】皖南医学院附属弋矶山医院神经内科，安徽芜湖 241001;皖南医学院附属弋矶山医院神经内科，安徽芜湖 241001;皖南医学院附属弋矶山医院神经内科，安徽芜湖 241001;皖南医学院附属弋矶山医院神经内科，安徽芜湖
241001;皖南医学院附属弋矶山医院神经内科，安徽芜湖 241001;皖南医学院附
属弋矶山医院神经内科，安徽芜湖 241001;皖南医学院附属弋矶山医院神经内科，安徽芜湖 241001
【正文语种】中文
【中图分类】R543.4
【相关文献】
1.颈动脉内膜切除术治疗颈动脉次全或完全闭塞患者的术中超声评估 [J], 刘玉梅;刘蓓蓓;孟秀峰;杨洁;李景植;李响;焦力群;华扬
2.颈动脉内膜切除术治疗颈动脉次全或完全闭塞患者的术前超声评估 [J], 刘玉梅;赵新宇;夏明钰;高明杰;张楠;李莉;焦力群;华扬
3.颈动脉内膜切除术治疗颈动脉极重度狭窄或闭塞患者可行性和安全性的评价 [J], 焦力群;宋刚;华扬;王天龙;蔡兵;谌燕飞;王亚冰;马妍;凌锋
4.支架成形术联合个体化认知疗法干预重度颈动脉狭窄合并对侧颈动脉闭塞患者的临床有效性分析 [J], 李庆镇
5.颈动脉粥样硬化性大血管闭塞与心源性栓塞性大血管闭塞患者侧支循环及临床预后的比较研究 [J], 杨蕾;付胜奇;石宝洋;秦历杰;王龙安
因版权原因，仅展示原文概要，查看原文内容请购买。