颈动脉夹层专业知识讲座培训课件

颈动脉夹层专业知识讲座动脉夹层的定义动脉剥离(arterdissection)是血液进入动脉壁形成血肿或动脉壁内自发性血肿,使血管壁间剥离,导致动脉管腔狭窄或血管破裂如果形成瘤样突起，称为夹层动脉瘤

(dissectinganeurysm)2颈动脉夹层专业知识讲座动脉夹层模式图TheNeurologist2008;14:66–733颈动脉夹层专业知识讲座颈动脉夹层的模式图NEnglJMed.200122;344(12):898-9064颈动脉夹层专业知识讲座病例分享5颈动脉夹层专业知识讲座病例分享6颈动脉夹层专业知识讲座病例分享Neurosurgery.43(2):357-3597颈动脉夹层专业知识讲座病例分享8颈动脉夹层专业知识讲座病例分享9颈动脉夹层专业知识讲座DSA常见征象10颈动脉夹层专业知识讲座卒中或者TIA的发病机制栓子？血流动力学？11颈动脉夹层专业知识讲座TCD栓子监测TraumaticSpontaneousTotalNo.10717TCDEmboli6（60%）4（58%）10（59%）Stroke.1996;27:1226-123012颈动脉夹层专业知识讲座影像学特点与发病机制Stroke.1998;29:2646-2648.13颈动脉夹层专业知识讲座抗栓开始和结束的时间14颈动脉夹层专业知识讲座局部症状和缺血的时间间隔TimeIntervalBetweenFirstLocalandIschemicSignsStudyTIACompletedstrokesFisher(1982)Minsto5mo1hourto"severalweeks"Mean:26±45dMean:7.8±9dHartandEaston(1983)SeveralhoursordaysBiller(1986)Afewhoursto7daysfromtraumatosymptomsMokri(1990)Afewminsto2wksBiousseMinsto66dMinsto31dMean:10.5±13.5dMean:5±6.5dStroke.1995;26:235-23915颈动脉夹层专业知识讲座抗栓治疗的时限动脉夹层最初3～6个月有再发卒中的风险6个月后很少再发16颈动脉夹层专业知识讲座颈动脉夹层

抗凝vs抗血小板17颈动脉夹层专业知识讲座19颈动脉夹层专业知识讲座2008meta-analysisMedlineandPubMedweresearchedfrom1966to8April2007cervicalarterydissection34non-randomisedstudies762patientsJNNP,2008;79;1122-112720颈动脉夹层专业知识讲座Outcome:StrokeJNNP,2008;79;1122-112721颈动脉夹层专业知识讲座Outcome:TIA+StrokeJNNP,2008;79;1122-112722颈动脉夹层专业知识讲座Outcome:Stroke+DeathJNNP,2008;79;1122-112723颈动脉夹层专业知识讲座2008meta-analysisConclusions对于颈动脉夹层的患者，没有证据支持抗凝治疗优于抗血小板治疗需要前瞻性的随机对照试验对比抗凝治疗和抗血小板治疗的有效性JNNP,2008;79;1122-112724颈动脉夹层专业知识讲座AspirinvsanticoagulationincarotidarterydissectionNeurology®2009;72:1810–1815Prospectivelycollecteddatafrom298consecutivepatientswithsICAD，nonrandomizedAnticoagulation(n~96)AspirinProspectivelycollecteddataofconsecutivepatientswithsICAD(n~202)newcerebralischemiceventsOutcomeOutcomesymptomaticintracranialhemorrhagemajorextracranialbleeding25颈动脉夹层专业知识讲座OutcomeNeurology®2009;72:1810–181526颈动脉夹层专业知识讲座Conclusions局限性：非随机的研究自发颈动脉夹层的患者其新发生的脑和视网膜缺血事件的发生频率较低新发事件与抗栓治疗的方法可能无关（抗凝vs抗血小板）27颈动脉夹层专业知识讲座最大型的研究CADISS仍在进行中CADISSCervicalArteryDissectioninStrokeStudyprospectivemulticentrerandomisedcontrolledtrialinacute(within7daysofonset)carotidandvertebralarterydissectionIntracerebralarterydissectionisexcludedIntJStroke.2007Nov;2(4):292-628颈动脉夹层专业知识讲座CADISS-DesignAntiplatelettherapyaspirin,dipyridamoleorclopidogrelaloneorindualcombinationAnticoagulationtherapyheparinfollowedbywarfarinaimingforanInternationalNormalisedRatio(INR)intherange2–3foratleast3monthsSamplesize-3000IntJStroke.2007Nov;2(4):292-629颈动脉夹层专业知识讲座2011AHA二级预防指南（总结）合并缺血性卒中或者TIA的颅外颈动脉或者椎动脉夹层的患者，抗栓治疗至少3-6个月

(ClassIIa;LevelofEvidenceB).合并缺血性卒中或者TIA的颅