頸動脈夾層電子教案

1、頸動脈夾層頸動脈夾層動脈夾層模式圖The Neurologist 2008;14: 6673頸動脈夾層的模式圖N Engl J Med. 2001 22;344(12):898-906病例分享病例分享病例分享Neurosurgery. 43(2):357-359病例分享病例分享DSA常見征象栓子？血流動力學(xué)？TCD 栓子監(jiān)測TraumaticSpontaneousTotalNo.10717TCD Emboli6（60%）4（58%）10（59%）Stroke.1996;27:1226-1230影像學(xué)特點與發(fā)病機制Stroke. 1998;29:2646-2648.局部癥狀和缺血的時間間隔Tim

2、e Interval Between First Local and Ischemic SignsStudyTIACompleted strokesFisher(1982)Mins to 5 mo1 hour to several weeksMean: 2645 dMean: 7.89 dHart and Easton(1983)Several hours or daysBiller(1986)A few hours to 7 days from trauma to symptomsMokri(1990)A few mins to 2 wksBiousseMins to 66 dMins to

3、 31 dMean: 10.513.5 dMean: 56.5 dStroke. 1995;26:235-239抗栓治療的時限動脈夾層最初36個月有再發(fā)卒中的風(fēng)險6個月后很少再發(fā)很多學(xué)者傾向于抗凝Stroke. 2007;38:2605-26112008 meta-analysisMedline and PubMed were searched from 1966 to 8 April 2007cervical artery dissection34 non-randomised studies762 patientsJNNP,2008;79;1122-1127Outcome:StrokeJN

4、NP,2008;79;1122-1127Outcome:TIA+StrokeJNNP,2008;79;1122-1127Outcome:Stroke+DeathJNNP,2008;79;1122-11272008 meta-analysis Conclusions對于頸動脈夾層的患者，沒有證據(jù)支持抗凝治療優(yōu)于抗血小板治療需要前瞻性的隨機對照試驗對比抗凝治療和抗血小板治療的有效性JNNP,2008;79;1122-1127Aspirin vs anticoagulation in carotid artery dissectionNeurology 2009;72:18101815Prospec

5、tively collected data from 298 consecutive patients with sICAD，nonrandomizedAnticoagulation(n96)AspirinProspectively collecteddata of consecutive patients with sICAD(n202)new cerebral ischemic eventsOutcomeOutcomesymptomatic intracranial hemorrhagemajor extracranial bleedingOutcomeNeurology 2009;72:

6、18101815Conclusions局限性：非隨機的研究自發(fā)頸動脈夾層的患者其新發(fā)生的腦和視網(wǎng)膜缺血事件的發(fā)生頻率較低新發(fā)事件與抗栓治療的方法可能無關(guān)（抗凝 vs 抗血小板）最大型的研究CADISS仍在進行中CADISSCervical Artery Dissection in Stroke Studyprospective multicentre randomised controlled trialin acute (within 7 days of onset) carotid and vertebral artery dissectionIntracerebral artery di

7、ssection is excludedInt J Stroke. 2007 Nov;2(4):292-6 CADISS- DesignAntiplatelet therapyaspirin, dipyridamole or clopidogrel alone or in dual combinationAnticoagulation therapyheparin followed by warfarin aiming for an International Normalised Ratio (INR) in the range 23 for at least 3 monthsSample size-3000Int J Stroke. 2007 Nov;2(4):292-6 2011 AHA 二級預(yù)防指南（總結(jié)）合并缺血性卒中或者TIA的顱外頸動脈或者椎動脈夾層的患者，抗栓治療至少3-6個月 (Class IIa; Level of Evidence B).合并缺血性卒中或者TIA的顱外頸動脈或者椎動脈夾層的患者，應(yīng)該選擇抗血小板治療還是抗凝治療還不清楚 (Class IIb; Level of Evidence B)(