1例颈动脉夹层致急性缺血性卒中患者静脉溶栓桥接血管内治疗体会并文献复习

代金龙; 边哲; 张嘉树; 李蕊; 王静悦; 叶宏远; 刘丽萍; 韩悦; 彭延波

doi:10.16766/j.cnki.issn.1674-4152.004192

1例颈动脉夹层致急性缺血性卒中患者静脉溶栓桥接血管内治疗体会并文献复习

doi: 10.16766/j.cnki.issn.1674-4152.004192

代金龙^{1, 2},
边哲³,
张嘉树¹,
李蕊¹,
王静悦³,
叶宏远³,
刘丽萍¹,
韩悦¹,
彭延波^3, ,

1.
华北理工大学临床医学院，河北唐山 063000
2.
遵化市人民医院急诊科，河北遵化 064200
3.
华北理工大学附属医院神内2科，河北唐山 063000

详细信息

通讯作者:
彭延波，E-mail：15203156268@163.com

中图分类号: R543.4 R743.3
计量
- 文章访问数: 5
- HTML全文浏览量: 3
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-09-08
- 网络出版日期: 2025-11-17

Experience of intravenous thrombolytic bridging intravascular therapy and literature review in a patient with acute ischemic stroke caused by carotid artery dissection

1.
North China University of Science and Technology Clinical School, Tangshan, Hebei 063000, China

摘要

摘要: 颈动脉夹层所致急性脑梗死的临床诊治尚有争议，本文回顾性分析1例颈动脉夹层致急性脑梗死患者的临床治疗。颈动脉夹层致急性脑梗死患者发病后先接受阿替普酶(0.9 mg/kg)静脉溶栓，症状未显著改善桥接血管内治疗(左侧颈内动脉支架置入术)等处理，临床症状完全缓解，美国国立卫生研究院卒中量表评分由18分改善至出院时的0分。随访3个月，患者无新发临床症状。结合PubMed、万方及中国知网2010—2024年文献报道的52例颈动脉夹层致急性脑梗死患者资料，对于该类患者，可采取血管内治疗(支架植入、抗栓等)方案，及时处理因夹层导致的闭塞血管，从而获得良好预后。
- 颈动脉夹层 /
- 急性脑梗死 /
- 血管内治疗
Abstract: The clinical diagnosis and management of acute cerebral infarction resulting from carotid artery dissection remain a topic of debate. A patient with acute cerebral infarction caused by carotid artery dissection was initially treated with intravenous thrombolysis using alteplase (0.9 mg/kg). Due to inadequate clinical improvement, bridging endovascular therapy (stent placement in the left internal carotid artery) was performed, resulting in complete clinical resolution. The National Institutes of Health stroke scale (NIHSS) score improved from 18 at admission to 0 upon discharge. At the 3-month follow-up, no new clinical symptoms were observed in the patient. Based on data from 52 patients with acute cerebral infarction caused by carotid artery dissection reported in PubMed, Wanfang, and CNKI.com between 2010 and 2024, it is suggested that endovascular therapy (such as stent implantation or anti-thrombolysis) may be employed for the timely management of vascular occlusion resulting from dissection in order to achieve favorable outcomes.
- Carotid artery dissection /
- Acute cerebral infarction /
- Endovascular therapy

HTML全文

图 1 头颅MRA

注：左侧颈内动脉起始部闭塞，左侧大脑中动脉M1段重度狭窄。

Figure 1. Head and neck MRA

下载: 全尺寸图片幻灯片

图 2 脑血管造影

注：A为左侧颈内动脉眼段以远、左侧大脑中动脉、左侧大脑前动脉A1段再通，血流速度较好，患者左侧颈内动脉近段夹层形成；B为左侧颈内动脉近段夹层形成，呈双腔征；C为左侧颈内动脉病变段再通；D为左侧大脑中动脉及左侧大脑前动脉主干及分支管腔通畅、血流速度良好。

Figure 2. Cerebral angiography

下载: 全尺寸图片幻灯片

表 1 52例颈动脉夹层患者的临床表现、发病危险因素、治疗方案及预后

Table 1. Clinical manifestations, risk factors, treatment regimens, and prognosis of 52 patients with carotid artery dissection

项目	例(%)
主要症状和体征
肢体无力	48(92.3)
Honor征	6(11.5)
言语不利	36(69.2)
头痛	15(28.8)
复视	2(3.8)
意识障碍	16(30.8)
危险因素
高血压	18(34.6)
糖尿病	2(3.8)
上呼吸道感染	3(5.8)
偏头痛	18(34.6)
颈部外伤	12(23.1)
吸烟	9(17.3)
饮酒	7(13.5)
狭窄程度≥75%	23(44.2)
NIHSS评分>15分	18(34.6)
治疗方案
血管内治疗	20(38.4)
药物治疗	32(61.5)
溶栓	8(15.3)
预后
死亡	1(1.9)
致残	2(3.8)
血管再通	43(82.7)
NIHSS评分>15分血管内治疗	12(66.7)
血管狭窄≥75%血管内治疗	19(82.6)
出院mRs评分 < 2分	49(94.2)
复发	0
注：mRs评分为改良Rankin量表(modified Rankin scale)评分。

下载: 导出CSV

参考文献(24)

[1]	黎丹丹, 罗鑫, 涂江龙. 颈内动脉夹层合并同侧大脑中动脉血栓性闭塞1例报告[J]. 中风与神经疾病杂志, 2021, 38(2): 161-162. LI D D, LUO X, TU J L. Endovascular management strategy for patients with acute occlusive internal carotid artery dissection combined with tandem middle cerebral artery occlusion[J]. Journal of Apoplexy and Nervous Diseases, 2021, 38(2): 161-162.
[2]	李明磊. 24例颈部动脉夹层的临床和影像学分析[D]. 郑州: 郑州大学, 2018. LI M L. Clinical and Imaging Analysis of 24 Cervical Arterial Dissections[D]. Zhengzhou: Zhengzhou University, 2018.
[3]	PITTOCK S J, MORONEY J T, ALEXANDER M, et al. Traumatic bilateral carotid dissection with concomitant cerebral infarction[J]. J Emerg Med, 2001, 20(1): 33-38. doi: 10.1016/S0736-4679(00)00284-5
[4]	李福滔, 张素平. 单侧颈内动脉夹层致脑梗死1例报道[J]. 医学信息, 2018, 31(11): 191-192. LI F T, ZHANG S P. A case report of unilateral internal carotid artery dissection causing cerebral infarction[J]. Journal of Medical Information, 2018, 31(11): 191-192.
[5]	车秀娟, 邵志刚, 张振宇, 等. 颈部按摩相关颈动脉夹层致急性脑梗死血管内治疗2例并文献复习[J]. 神经损伤与功能重建, 2022, 17(9): 542-544. CHE X L, SHAO Z G, ZHANG Z Y, et al. Endovascular treatment of acute cerebral infarction caused by cervical artery dissection related to neck massage and literature review[J]. Neural Injury And Functional Reconstruction, 2022, 17(9): 542-544.
[6]	曹勇军, 肖国栋, 章春园, 等. 颈动脉夹层所致分水岭脑梗死患者的病因诊断和治疗1例病例报告[J]. 中国卒中杂志, 2011, 6(z1): 15-18. CAO Y J, XIAO G D, ZHANG C Y, et al. Diagnosis and Treatment for a Case of Cerebral Watershed Infarction by Carotid Artery Dissection[J]. Chinese Journal of Stroke, 2011, 6(z1): 15-18.
[7]	李海军, 于盈. 颈动脉夹层在神经内科误诊3例分析[J]. 心脑血管病防治, 2012, 12(4): 4336-4339. LI H J, YU Y. Analysis of 3 misdiagnosed cases of carotid artery dissection in neurology[J]. Prevention and Treatment of Cardio-cerebrovascular Diseases, 2012, 12(4): 4336-4339.
[8]	李子艳, 何洁, 王玉兰, 等. 颈动脉夹层致青年卒中一例报道[J]. 内蒙古医学杂志, 2012, 44(S5): 150-151. LI Z Y, HE J, WANG Y L, et al. A case report of carotid artery dissection causing stroke in young people[J]. Inner Mongolia Medical Journal, 2012, 44(S5): 150-151.
[9]	王广涛, 王启弘. 颈总动脉钝性伤致迟发性脑梗死1例[J]. 浙江实用医学, 2012, 17(1): 76-78. WANG G T, WANG Q H. A case of delayed cerebral infarction caused by blunt injury of the common carotid artery[J]. Zhejiang Practical Medicine, 2012, 17(1): 76-78.
[10]	刘世民, 曹贤敏, 赵菊红, 等. 颅外段颈内动脉夹层抗血小板聚集治疗再通1例报道并文献复习[J]. 江西医药, 2017, 52(7): 658-659. LIU S M, CAO X M, ZHAO J H, et al. A case report and literature review of anti-platelet aggregation therapy for recanalization of extracranial internal carotid artery dissection[J]. Jiangxi Medical Journal, 2017, 52(7): 658-659.
[11]	方兴, 徐子奇, 袁怀武, 等. 脑动脉夹层28例临床分析[C]//浙江省科学技术协会. 2015年浙江省神经病学学术年会论文汇编, 舟山, 2015: 92-93.
[12]	陈云波. 头颈部动脉夹层18例影像和临床特点、治疗及随访[J]. 中风与神经疾病杂志, 2014, 31(7): 628-632. CHEN Y B. Imaging and clinical characteristics, treatment and follow-up of 18 cases of head and neck artery dissection[J]. Journal of Apoplexy and Nervous Diseases, 2014, 31(7): 628-632.
[13]	乔兴茂. 外伤性颈动脉血栓栓塞性脑梗死一例[J]. 中国卒中杂志, 2009, 4(8): 678-681. QIAO X M. A case of traumatic carotid artery thromboembolic cerebral infarction[J]. Chinese Journal of Stroke, 2009, 4(8): 678-681.
[14]	孟坤, 张俊红, 窦连伟, 等. 支架治疗颈动脉夹层致进展性卒中1例报告并文献复习[J]. 中风与神经疾病杂志, 2014, 31(1): 84-85. MENG K, ZHANG J H, DOU L W, et al. A case report and literature review of stent treatment for progressive stroke caused by carotid artery dissection[J]. Journal of Apoplexy and Nervous Diseases, 2014, 31(1): 84-85.
[15]	侯宝军, 李淑婷, 李思颉, 等. 支架治疗颈内动脉夹层动脉瘤一例[J]. 中华临床医师杂志: 电子版, 2013, 7(3): 1337-1338. HOU B J, LI S T, LI S J, et al. A case of stent treatment for internal carotid artery dissection aneurysm[J]. Chinese Journal of Clinicians(Electronic Edition), 2013, 7(3): 1337-1338.
[16]	仲伟斌, 王鹏飞, 于进超, 等. 支架治疗颈动脉夹层导致急性脑梗死2例报告及文献复习[J]. 中国卒中杂志, 2022, 17(6): 653-657. ZHONG W B, WANG P F, YU J C, et al. Report of 2 cases of stent treatment for acute cerebral infarction caused by carotid artery dissection and literature review[J]. Chinese Journal of Stroke, 2022, 17(6): 653-657.
[17]	鲁明, 陆菁菁, 杨帆. 颈动脉夹层致急性缺血性卒中患者静脉溶栓一例[J]. 中国脑血管病杂志, 2020, 17(12): 758-760. LU M, LU J J, YANG F. A case of intravenous thrombolysis in a patient with acute ischemic stroke caused by carotid artery dissection[J]. Chinese Journal of Cerebrovascular Disease, 2020, 17(12): 758-760.
[18]	吕科峰, 罗根培, 李润雄, 等. 以脑梗死为首发症状的主动脉夹层并血管内治疗1例报告[C]//国际脑血管病高峰论坛组委会. 中国介入神经病学大会2019-第15届国际脑血管病高峰论坛, 南京, 2019: 126-129.
[19]	周国庆, 肖国栋, 曹勇军, 等. 运动相关颈内动脉夹层致脑梗死的临床及影像学特点(附1例报告)[J]. 临床神经病学杂志, 2011, 24(1): 56-58. ZHOU G Q, XIAO G D, CAO Y J, et al. Clinical and imaging characteristics of cerebral infarction caused by exercise-related internal carotid artery dissection (with a case report)[J]. Journal of Clinical Neurology, 2011, 24(1): 56-58.
[20]	李雯娴, 李国华, 黄立安. 自发性颈动脉夹层致脑梗死1例[J]. 广东医学, 2015, 36(11): 1797. LI W X, LI G H, HUANG L A. A case of cerebral infarction caused by spontaneous carotid artery dissection[J]. Guangdong Medicine Journal, 2015, 36(11): 1797.
[21]	邬健. 左侧自发性颈动脉夹层致脑梗死静脉溶栓治疗1例[J]. 中国乡村医药, 2019, 26(18): 50-51. WU J. A case of intravenous thrombolysis for cerebral infarction caused by spontaneous left carotid artery dissection[J]. Chinese Journal of Rural Medicine and Pharmacy, 2019, 26(18): 50-51.
[22]	叶凡龙, 王子高, 潘晓黎, 等. 自发性双侧颈内动脉夹层伴脑梗死一例并文献复习[J]. 中华全科医师杂志, 2017, 16(5): 391-394. YE F L, WANG Z G, PAN X L, et al. A case of spontaneous bilateral internal carotid artery dissection with cerebral infarction and literature review[J]. Chinese Journal of General Practitioners, 2017, 16(5): 391-394.
[23]	黄良通, 徐灵燕. 依达拉奉右莰醇联合替罗非班对急性脑梗死患者脑血流动力学及氧化应激的影响[J]. 中华全科医学, 2023, 21(7): 1097-1100. doi: 10.16766/j.cnki.issn.1674-4152.003058 HUANG L T, XU L Y. Effects of edaravone dexborneol combined with tirofiban on cerebral hemodynamics and oxidative stress in patients with acute cerebral infarction[J]. Chinese Journal of General Practice, 2023, 21(7): 1097-1100. doi: 10.16766/j.cnki.issn.1674-4152.003058
[24]	YAGHI S, ENGELTER S, DEL BRUTTO V J, et al. Treatment and outcomes of cervical artery dissection in adults: a scientific statement from the American Heart Association[J]. Stroke, 2024, 55(3): e91-e106.