颅内动脉夹层的发病机制、影像学特点和自然病程

颅内动脉夹层相比颅外动脉夹层较少见，且临床表现缺乏特异性，既可以表现为缺血性
事件，也可以表现为出血性事件，多发生于年轻人。由于夹层发生部位、形成时机以及病变严重程度
不同，临床表现各种各样，影像学对于确诊动脉夹层至关重要。颅内动脉夹层易复发，且死亡率较高，
除无症状或症状轻微的患者给予保守治疗或随访观察外，对于症状较重或进展性动脉夹层患者，应
给予积极治疗，包括血管内治疗。     

3D T_1黑血序列:颈动脉夹层诊断的得力助手

正颈部动脉夹层是青年卒中的重要病因,在45岁以下缺血性卒中患者中高达10%~25%,颈部动脉夹层引起卒中的机制主要是动脉-动脉栓塞和血流动力学受损。早期准确的诊断可帮助患者选择合适的治疗方式以预防卒中的发生和复发。一般来说,颈部动脉夹层的诊断需要结合病史、临床表现和影像学等检查结果。但颈部动脉夹层的临床表现没有特异性,既可以表现为单纯头痛、颈部疼痛、Horner综合征、颅神经麻痹等局部症状,也可以表现为短暂性     

椎-基底动脉夹层的临床特点

目的 分析椎-基底动脉夹层所致后循环缺血的临床特点。方法 对7例经磁共振血管造影（MRA）或全脑数字减影血管造影（DSA）证实的椎-基底动脉夹层患者的临床资料进行分析。结果 7例患者均表现为后循环缺血症状。其中1例患者经MRA诊断为椎动脉夹层，1例患者为尸检后确诊为椎-基底动脉夹层，另5例患者经DSA诊断。1例患者进行尿激酶溶栓治疗，3例进行抗血小板聚集治疗，3例进行支架成形术合并抗血小板聚集治疗。除1例溶栓治疗的患者死亡外，其余6例患者随访3～24个月均未发生缺血性卒中。结论 椎-基底动脉夹层是引起后循环缺血的原因之一，正确识别椎-基底动脉夹层对于患者预后至关重要。抗血小板聚集治疗和血管内治疗可能为椎-基底动脉夹层的有效治疗方法。     

巨大占位型颅内夹层动脉瘤

正颅内动脉夹层外壁向外突起形成瘤样扩张,称为颅内夹层动脉瘤。临床表现为头痛、缺血性或出血性症状,体积较大者压迫邻近脑组织或脑神经而引起相应症状。影像学须同时关注管腔和管壁两方面变化,MRI是重要诊断手段,其他常用方法还包括DSA、CTA和MRA等。DSA可以动态观察颅内夹层动脉瘤的血流方式和管腔构型,典型征象包括"串珠征",即动脉瘤腔不规则或梭形扩张伴或不伴瘤腔近端和(或)远端狭窄;"双腔征",即不规则狭窄和(或)迂曲扩张的管腔(图1a),静脉期可见     

颅内段椎基底动脉夹层动脉瘤诊疗研究进展

颅内段椎基底动脉夹层动脉瘤（IVBDAs）是发生于椎动脉颅内段和基底动脉的以动脉瘤 形成为主要形态学改变的动脉夹层，发病原因及确切机制尚不完全明确。其临床表现不具有特异性，还 可能随时间进展演变转换，影像表现复杂多变，人们对IVBDAs的流行病学、自然病史、病因及发病机制、 诊断方法及治疗策略尚存有争议，现参考近年发表的文献资料，综述IVBDAs的研究进展。     

颅内动脉夹层的影像学研究进展

颅内动脉夹层是青年卒中的常见原因,其发病形式主要表现为蛛网膜下腔出血或后循环 缺血,致残率和病死率都很高,因其缺乏特异性症状和体征,极易造成漏诊或误诊,亟须制定统一 的临床影像诊断和分类诊断标准。本文就颅内动脉夹层的影像学研究现状和相关进展加以探究。     

椎-基底动脉夹层致缺血性卒中31例临床分析

目的探讨椎-基底动脉夹层(Vertebrobasilar artery dissection,VBAD)所致缺血性卒中的临床、影像学特点、治疗方法及预后。方法回顾性分析31例VBAD所致缺血性卒中的患者的临床资料。结果短暂性脑缺血发作3例,脑梗死28例,颅内组25例,颅外组6例。28例后循环脑梗死机制比较,血栓栓塞致脑梗死颅内组(0例)和颅外组(3例)比较差异具有统计学意义(P0.05);保守治疗17例,均予抗血小板或抗凝治疗,颅内组抗凝治疗1例,抗血小板聚集治疗12例,颅外组抗凝治疗4例,抗血小板治疗0例,颅内组、颅外组抗凝、抗血小板聚集治疗比较差异具有统计学意义(P0.05);影像学表现中,夹层动脉瘤16例,管壁增厚或双腔5例,狭窄型6例,闭塞型4例,颅外组和颅内组夹层影像学特征比较无统计学意义(P0.05)。结论颅内VBAD与颅外VBAD致缺血性卒中机制不同,颅外主要为栓塞性梗死,颅内主要为穿支闭塞性梗死。VBAD保守治疗中,颅内病变治疗以抗血小板聚集为主,颅外病变治疗以抗凝治疗为主。积极治疗能改善VBAD致脑梗死神经缺损症状。     

烟雾病颅内血流相关性动脉瘤的血管内治疗

目的探讨烟雾病患者颅内血流相关性动脉瘤的临床特点及血管内治疗方法。方法回顾性分析11例经全脑血管造影证实的烟雾病合并颅内血流相关性动脉瘤患者的临床表现和血管内栓塞治疗方法。结果 11例中7例表现为颅内出血,4例表现为缺血症状;9个动脉瘤位于Willis环周围,1个位于大脑后动脉顶枕支,1个位于脉络膜后内侧动脉;11个动脉瘤除1例外周型动脉瘤因超选困难外其余10例均成功行血管内栓塞治疗,随访均获良好疗效。结论烟雾病患者颅内血流相关性动脉瘤可有出血或非动脉瘤性临床表现,此类动脉瘤可分为累及Willis环的主要动脉型动脉瘤和累及侧支为主的外周动脉型动脉瘤;血管内栓塞治疗烟雾病患者的颅内动脉瘤是安全有效的,对外周动脉型动脉瘤可予对症保守治疗。     

椎动脉梭形动脉瘤的研究进展

<正>椎动脉瘤占所有颅内动脉瘤的0.5%~3%,好发部位为椎动脉干。大部分椎动脉瘤为梭形动脉瘤,其直径多为7 mm或更大(平均13 mm)[1]。椎动脉梭形动脉瘤是由动脉管壁梭形扩大形成的,多为夹层动脉瘤。临床表现为蛛网膜下腔出血、颅神经及脑干、小脑压迫症状。绝大部分椎动脉梭形动脉患者以蛛网膜下腔出血起病。在椎基底动脉夹层动脉瘤中并发蛛网膜下腔出血者的发生率约占1/2以上,且3%     

儿童颅内动脉瘤的临床特点与治疗分析

目的 探讨儿童颅内动脉瘤的临床特点、治疗方法及其疗效。方法 回顾性分析2012年1月至2023年1月收治的33例小儿颅内动脉瘤的临床资料。结果 年龄6～17岁，平均（13.7±15.1）岁。33例共35枚动脉瘤，其中前循环26枚，后循环9枚；26例呈急性发病，合并蛛网膜下腔出血17例、脑内血肿8例、血肿破入脑室3例、脑积水1例。12例采取动脉瘤夹闭术，术后6个月mRS评分0～1分10例，2分1例，3分1例。7例选择血管内治疗，术后6个月m RS评分0～1分。3例巨大、夹层动脉瘤行颅外-颅内动脉分流术，术后6个月mRS评分0、1、2分各1例。10例选择保守治疗，6个月随访期内未新发卒中事件。1例放弃治疗，自动出院1周后死亡。结论 儿童颅内动脉瘤以男性多见，后循环动脉瘤占比高，临床症状多样；治疗上，建议首选动脉瘤夹闭术，对后循环动脉瘤及巨大、夹层动脉瘤，则可以选择血管内治疗或颅外-颅内动脉分流术。     

Intracranial artery dissection

The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be identified: a subintimal or subadventitial dissection. It is suggested that a subintimal dissection results in luminal stenosis, thromboembolism and subsequently cerebral ischaemia, whilst a subadventitial IAD could result in the formation of a pseudo‐aneurysm and compression on brainstem or cranial nerves. Rupture of such a dissecting aneurysm causes SAH. The exact cause of IAD remains unknown but several factors are associated with its development. Diagnosis is based on clinical presentation and specific features seen on multimodal neuroimaging. The management of IAD depends on the clinical presentation. In the case of cerebral ischaemia, anticoagulants or antiplatelet agents are used, whilst in the case of SAH endovascular treatment is primarily advocated. Prognosis depends on clinical presentation. Presentation with SAH has a worse prognosis.     

Intracranial dissections: A pictorial review of pathophysiology,imaging features,and natural history

Intracranial artery dissections (IAD) are uncommon entities associated with high rates of morbidity and mortality. Certain ethnic groups and patients with underlying connective tissue disorders may be at a higher risk of developing IAD, but these relationships are unclear due to the condition's rarity. Patients often present with a prodromal headache followed by subarachnoid hemorrhage (SAH) or ischemic stroke. Imaging findings are critical to establishing the diagnosis, as the lesions have a myriad of presentations based on the severity, location, and timing of the dissection. Lesions that present with ischemia are at high risk for future ischemia but low risk of future hemorrhage, whereas lesions, which present with hemorrhage have a high rate of re-bleeding if left untreated. There are no evidence-based guidelines for medical or surgical management. Several endovascular and surgical techniques have been used to prevent or treat hemorrhage by ligating the parent artery or reconstructing the vessel wall. Outcomes are generally poorer in patients with IAD than cervical artery dissection, particularly in those who suffer SAH.     

动脉粥样硬化性和心源性颅内大血管闭塞对血管内治疗反应性差异研究

目的探讨动脉粥样硬化性和心源性前循环颅内大血管闭塞患者的临床特点以及对血管内治疗反应性的差异。方法回顾性分析行血管内治疗的前循环颅内大血管闭塞的急性缺血性卒中患者的临床资料,比较动脉粥样硬化性和心源性大血管闭塞患者的临床特点、血管内治疗方式、血管开通情况、围手术期并发症及术后神经功能改善状况等。结果共纳入行血管内治疗的前循环大血管闭塞性缺血性卒中患者46例,其中动脉粥样硬化性组24例,心源性栓塞组22例,相比心源性栓塞组,动脉粥样硬化组中吸烟(33%vs 9%,P=0.046)、男性(75%vs 36%,P=0.008)比例显著较高,心房颤动史显著较低(0%vs 82%,P0.001)。动脉粥样硬化组联合使用血管成形术的比例较高(67%vs 27%,P=0.008)。两组患者血管内治疗最终整体再通率、术中并发症、术后神经功能改善方面均未见显著差异。结论动脉粥样硬化与心源性栓塞导致的大血管闭塞性急性前循环缺血性卒中相比,其危险因素和血管内开通措施有所不同,动脉粥样硬化性大血管闭塞患者血管内治疗往往需要联合血管成形术。     

Clinical and Radiological Characteristics of Intracranial Artery Dissection Using Recently Proposed Diagnostic Criteria

Background: Data on the clinical and radiological characteristics of intracranial artery dissection (IAD) have remained limited. Our purpose was to reveal the clinical and radiological characteristics of IAD according to diagnostic criteria for IAD as recently reported by a group of international experts. Methods: Patients were retrospectively enrolled using a prospective single-center stroke registry between 2011 and 2016. Baseline characteristics and radiological findings including conventional magnetic resonance imaging (MRI) sequences, magnetic resonance angiography (MRA), high-resolution 3-dimensional T1-weighted imaging (HR-3D-T1WI), and digital subtraction angiography were reviewed. We performed statistical comparisons to determine which findings from which modalities are useful. Results: We identified 118 patients with suspected artery dissection, with 64 patients (median age, 51 [interquartile range, 45-56) years; 16 women) finally meeting the criteria for definite (n = 47), probable (n = 15), or possible (n = 2) idiopathic IAD. Ischemic stroke alone was found in 31 patients (48%) on admission. There were 36 patients (56%) suffering from hypertension and 39 (61%) with smoking history. The vertebral artery alone was the most affected in 42 patients (66%). Intramural hematoma (IMH) was more frequently detected on HR-3D-T1WI than on conventional MRI/MRA (odds ratio, 4.72; 95% confidence interval, 1.71-13.00). In 54 patients (84%), the modified Rankin Scale score after 3 months was 0-1. Conclusions: Male dominance and age at IAD onset were similar to previous studies, and more than half had hypertension and smoking history. We confirmed that HR-3D-T1WI is useful for detecting IMH in the diagnostic criteria.     

Dissection of the posteroinferior cerebellar artery: clinical characteristics and long-term follow-up in five cases

BACKGROUND AND PURPOSE: Spontaneous isolated posteroinferior cerebellar artery (PICA) dissection is very rare. The aim of the study was to investigate the clinical manifestations, the neuroradiological aspects and the treatment of 5 cases collected in 5 years. METHODS AND RESULTS: From 1999 to 2003, five patients (40-71 years old) were hospitalized for PICA dissection. Two patients presented symptoms after cervical manipulation. No predisposing factor or traumatic cause was described in the other cases. The diagnosis was carried out by cerebral angiography in all the cases: in 4, angiography showed focal stenosis with saccular or fusiform dilatation of the artery at the site of the dissection; in 1 a double lumen aspect was described. One patient presented ischemic manifestations; he was treated with heparin. The others presented subarachnoid hemorrhage (SAH) and were treated by embolization (endovascular sacrifice of the PICA). No ischemic complication and no rebleeding were observed after sacrifice of the PICA. Three patients presented acute hydrocephalus and were treated with surgical derivation. The angiographic and clinical follow-up lasted more than 3 years. We assessed the long-term results with the Glasgow Outcome Score and the modified Rankin Score. A good recovery was achieved for 4 patients (modified Rankin Score 0); one patient who presented SAH and who was in bad clinical state on admission had a Glasgow Outcome Score of 3 and a modified Rankin Score of 4 three years later. CONCLUSION: Clinical course and prognosis are variable in PICA dissections. The treatment depends on the existence of a hemorrhagic event. In the group of patients presenting SAH, endovascular treatment was safe and effective. The long-term clinical results depend mainly on the clinical status on admission.     

Traumatic internal carotid artery dissection

Traumatic internal carotid artery dissection is a serious condition that may cause ischemic stroke in young patients. It has been under-diagnosed in the past. We present three cases of traumatic internal carotid artery dissection. The clinical manifestations include hemicrania, hemiparesis, partial Horner’s syndrome and cranial nerve palsy. Diagnosis is with carotid color Doppler ultrasound, CT angiography of the neck and conventional angiography. The outcome may be poor with hemiparesis, persistent vegetative state and death. We review the literature and discuss the clinical presentation, diagnosis, grading and treatment choices for traumatic internal carotid artery dissection and stroke.     

椎-基底动脉系统结构异常误诊二例

目的 椎-基底动脉系统结构异常目前被认为是脑卒中发生的原因之一,少见的因椎基底动脉压迫所致的临床症状可以被误诊为多种神经系统疾病,包括运动神经元病、炎性脱髓鞘及周围神经病等.方法 通过对我科近期收住的两例椎-基底动脉系统结构异常压迫延髓和舌下神经被误诊为运动神经元病及其他疾病患者进行分析,了解椎-基底动脉系统结构异常的临床表现、影像学特点、诊断标准、治疗和预后.结果 缺乏正确的影像学评估通常是导致椎-基底动脉系统结构异常被误诊的主要原因.头颅MRI\MRA\CTA是诊断椎-基底动脉系统结构异常的主要检查方法.针对此病,目前尚无有效的治疗方法,针对缺血性脑卒中为主要临床表现的患者主要以抗血小板聚集、调脂固斑、治疗脑血管病危险因素为主要治疗手段;针对以压迫为主要临床表现的患者,则可以通过充分的评估后进行手术治疗.结论 椎-基底动脉结构异常的临床表现多样,正确的影像学评估有利于早期诊断,调整治疗方案,减轻患者焦虑情绪.     

机械取栓和支架植入治疗动脉粥样硬化性颅内大血管闭塞疗效对比研究

目的对比机械取栓和支架植入两种血管内治疗方式对动脉粥样硬化性颅内急性大血管闭塞导致的急性缺血性卒中的疗效差异。方法回顾性分析我中心接受血管内治疗的颅内动脉粥样硬化性大血管闭塞导致的急性缺血性卒中患者,可回收支架组使用可回收支架取栓治疗作为第一治疗措施合并或不合并其他补救措施,支架植入组采取支架植入作为血管再通方式,比较两组患者再通率、临床预后及并发症情况等。结果共计64例患者纳入本研究,其中可回收支架组48例,支架植入组16例。可回收支架组初次使用可回收支架取栓后再通率仅仅为18.75%,37例接受了补救性治疗措施,两组最终再通率未见明显差异(P=0.566)。与可回收支架组相比,支架植入组术中操作时间明显较短(P0.01),两组患者术后48 h神经功能改善情况(P=0.885)、围手术期出血并发症(P=0.817)未见差异,术后3个月良好预后(P=0.884)以及死亡率(P=0.874)情况未见明显差异。结论对于动脉粥样硬化性大血管闭塞导致的急性缺血性卒中,单独使用可回收支架取栓效果欠佳,往往需要其他补救性治疗措施,直接支架植入治疗也是一种有效的治疗方式。     

“COVID-19 and cervical artery dissection- A causative association?”

COVID-19 is a pandemic disease which predominantly affects the respiratory system, however it also causes multi-organ dysfunction in a subset of patients. There is a growing evidence that it increases the propensity of strokes in younger patients. Besides producing a prothrombotic state, arterial dissection could be one of its many manifestations, increasing the risks of stroke. Herein, we report the first case of spontaneous bilateral vertebral artery dissection in a patient with COVID-19. 39-year female presented with spontaneous bilateral vertebral artery dissections without any instigating traumatic events and no history of connective tissue disorders. Whether this patient's vertebral artery dissections were triggered by exaggerated inflammatory response or arteriopathy secondary to COVID-19 remains speculative. Nonetheless, arterial dissection could be one of it's complications. It is important for the physicians to be aware of different clinical manifestations of COVID-19 as we manage these patients with no historical experience, to provide adequate care.