11例颈动脉盗血综合征临床分析

目的分析11例颈动脉盗血综合征(CSS)的临床表现和影像学特点,评估其侧支循环建立与代偿方式及不同治疗方式的预后,为CSS的诊治提供依据。方法纳入2016年1月~2016年5月住院治疗的CSS患者11例。所有患者均进行颈部血管彩超、头颅CT血管造影(CTA)或磁共振血管成像(MRA)、数字剪影血管造影(DSA)等检查明确CSS诊断,进行侧支循环代偿评估。11例CSS患者中,4例患者行颈动脉内膜剥除术(CEA),5例行颈动脉内支架植入术(CAS),2例颈动脉闭塞患者药物保守治疗。对11例患者在治疗3个月、6个月和1年后进行随访,并评估缺血性脑血管事件及改良RANKIN量表评分(mRs)。结果 11例CSS患者中,单侧颈内动脉病变7例,双侧颈内动脉病变4例。临床表现为短暂性脑缺血发作7例,分水岭梗死3例,腔隙性脑梗死1例;其中后循环缺血7例,前循环缺血4例。DSA评估侧支循环建立单以一级侧支循环(11例)和二级侧支循环(4例)开放为主。ASITN评分大部分为3~4级。治疗后随访,有2例行CAS的患者出院后出现不同时期卒中样症状,4例行CEA的患者随访期内均未发生卒中。CAS和CEA术后3个月、6个月和1年的mRs评分均有不同程度改善。结论 CSS患者多发生于颈动脉狭窄严重患者,其侧支循环开放良好,以一、二级侧支循环开放为主,临床表现以后循环缺血症状多见。CAS及CEA能改善颈动脉狭窄,可能成为CSS的治疗手段。

Clinical and imaging features of carotid steal syndrome: an analysis of 11 cases

Objective To investigate the clinical and imaging features of carotid steal syndrome (CSS), as well as collateral circulation establishment, compensation methods, and outcomes of different treatment modalities, and to provide a basis for the diagnosis and treatment of CSS.Methods A total of 11 patients with CSS who were hospitalized from January to May, 2016, were enrolled. Carotid color Doppler ultrasound, head CT angiography, magnetic resonance angiography, or digital subtraction angiography was performed for all patients to make a definite diagnosis of CSS and evaluate the compensation of collateral circulation. Of all 11 CSS patients, 4 underwent carotid endarterectomy (CEA), 5 underwent carotid artery stenting (CAS), and 2 patients with carotid artery occlusion underwent conservative pharmacotherapy. All the patients were followed up after 3 and 6 months and 1 year of treatment, and ischemic cerebrovascular events and the modified Rankin Scale (mRS) score were evaluated.Results Of all 11 CSS patients, 7 had lesions in the unilateral internal carotid artery and 4 had lesions in the bilateral internal carotid arteries; 7 had a clinical manifestation of transient ischemic attack, 3 had watershed infarction, and 1 had lacunar infarction; 7 patients had posterior circulation ischemia and 4 had anterior circulation ischemia. According collateral circulation establishment on DSA, all 11 patients had primary collateral circulation and 4 also had secondary collateral circulation. According to the ASITN score, most patients had a grade of 3-4. During the follow-up after treatment, two patients who underwent CAS experienced stroke-like symptoms in different periods after discharge, and four patients who underwent CEA did not experience stroke. The patients who underwent CAS or CEA had varying degrees of improvement in the mRS score at 3 and 6 months and 1 year after surgery.Conclusions Patients with severe carotid stenosis tend to develop CSS, with well established collateral circulation, mainly primary and secondary collateral circulation, and posterior circulation ischemia is a common clinical feature of CSS. CEA and CAS can improve carotid stenosis and thus may be used for the treatment of CSS.