| Cervical artery dissection(CAD)is an important factor in young patients suffered with stroke,which accounted for 1-2% among all the patients of stroke while 10-25% in the young patients(<45 years).Such a high incidence(10-25%)of stroke not only brought great burden to individuals,but also to the family,society and economy of country.The lack of domestic and foreign huge sample studies of epidemiology,diagnosis and treatment for cervical artery dissection and inefficient importance to the clinicians lead to misdiagnosis.Clinical manifestation in patients with cervical artery dissection is termed with many names as cervical artery dissection triad,ipsilateral head,neck and face pain,Horner syndrome and cerebral or retinal ischemic symptoms.Angiography is said to be the up to date and standard diagnosis of cervical artery dissection.However,with the development of non-invasive imaging techniques and high-resolution magnetic resonance imaging systems playing an increasingly important roles in the diagnosis and treatment of cervical artery dissection.Currently,there exist different opinions about the risk assessment of early recurrent stroke of cervical artery dissection.Some researchers believe high risk of recurrence and many opposed it,but antithrombotic treatment is crucial.Antithrombotic treatment is mainly of two types,one spanned 3 to 6 months while the other is anti-platelet treatment.Many hospitals tend to use current anticoagulant treatments,but the risk of cerebral hemorrhage is significantly increased,so the efficacy and safety of the two treatments are still the focus of the study.With the development of endovascular treatment,it is also used in the cervical artery dissection,but still lacks a large sample size to confirm its safety and efficacy.Recent years,statins are widely used in stroke,its non-lipid-lowering effect is now the focus of medical attention,whether the anti-inflammatory effect of statins in the therapy of cervical artery dissection has played a certain effect,but also we need to prove the problem.At present,we know little about the pathogenesis of cervical artery dissection and suggest that it may be associated with non-specific or hereditary arterial wall structure and / or abnormal function,hemodynamic changes,vascular wall inflammation,head and neck movement caused by vascular wall pressure Increased,recent infection,seasonal factors,and some common cerebrovascular risk factors such as hypertension,hyperlipidemia,men,smoking and other factors.So we urgent need to establish a model of cervical arterial dissection for large animals,to identify its pathogenesis,for the clinical treatment and prevention of the specified direction.Part 1 Retrospective analysis of the therapy of cervicocephalic arterial dissection(CCAD)OBJECTIVE: To investigate the effects of different treatments and different drugs on the prognosis of patients with cervicocephalic arterial dissection.METHODS: The clinical data of 94 patients with cervicocephalic arterial dissection were retrospectively analyzed from March 2003 to July 2014.The gender,age of onset,clinical manifestation,laboratory examination,dissection,drug treatment and endovascular treatment,anticoagulant treatment and antithrombotic treatment,statin treatment,mortality,and stroke recurrence rates were followed for 3 months of short-term follow-up and 3-year long-term follow-up studies.RESULTS: There were 88 patients,and the follow-up rate was 93.6% at 3 months.The 3 years’ follow-up rate was 86.2%.All patients at least 3 months of therapy,the severity of symptoms to admission NIHSS score to determine,after 3 months m Rs ≤ 2 that the prognosis is good.There were 2 patients died in 3 months,and 5 patients died in 3 years,the total mortality rate of 7.4%.2 patients got stroke recurrence in 3 months,and 7 patients in 3 years,the total recurrence rate of 9.6%.A total of 22 patients underwent endovascular stent implantation.The long-term effects of different treatments were analyzed by chi-square test.The effect of intravascular stent implantation was better than that of drug treatment group(χ2 =3.058,P=0.039);Drug treatments,the use of statin treatment group 3 months when the recurrence rate of stroke was lower than the non-statin treatment group(χ2 =2.250,P=0.041).There are 4 kinds of drug treatments: anticoagulant treatment,single oral antiplatelet treatment,dual antiplatelet treatment,anticoagulant combined single oral antiplatelet treatment.Chi-square test analysis for stroke recurrence rate in 3 months,significant differences in them(χ2 =13.795,P=0.003);There was a significant difference between single oral antiplatelet treatment and anticoagulation combined single oral antiplatelet treatment(χ2 =8.308,P=0.004);There was a significant difference between dual antiplatelet treatment and anticoagulation combined single oral antiplatelet treatment(χ2 =8.320,P=0.004).CONCLUSIONS: Male patients with TIA as the first symptom of the majority,while female patients with more common symptoms of dizziness;Head and neck trauma and massage will induce dissection,patients with migraine may be associated with the occurrence of dissection;Atherosclerosis has nothing to do with the occurrence of dissection;Vertebral artery dissection more in women,and intracranial arterial dissection more common in men;Carotid dissection occurs more in older people;Head and neck pain symptoms are more in the vertebral artery dissection;Intracranial arterial dissection leads to more neurological symptoms;Intravascular stent implantation is more effective than drug treatment in 3 months;The use of statins reduces stroke recurrence in patients within 3 months;There was no significant difference between anticoagulant treatment and antiplatelet treatment;anticoagulation combined single oral antiplatelet treatment of recent stroke recurrence rate of the highest,long-term no difference。Different treatment options and medication regimens have no significant effect on long-term mortality and stroke recurrence;The severity of onset symptoms had no significant effect on mortality and stroke recurrence.Part 2 The carotid artery dissection model of pig and preliminary study on the pathogenesisOBJECTIVE: To establish the model of porcine carotid artery dissection,and explore the occurrence and progress of the intercalation of inflammatory reaction.METHODS:We isolated the porcine carotid artery intimal and dilated balloon to establish the model under microscope,the imaging and pathological specimens were used to verify the success of the model.Vascular specimens were taken from the acute phase(72 hours)and the chronic phase(6 months)of the model animals,respectively,and the corresponding specimens of the sham operation group were examined by i TRAQ quantitative proteomics.RESULTS: Verification of porcine carotid artery dissection model by high-resolution magnetic resonance(HRMRI),vascular ultrasound and DSA,pathological HE staining shows the formation of true and false vessels,immunofluorescence stained CD31-labeled damaged endothelial cells;A total of 58 proteins in the carotid artery were detected by i TRAQ,among which 37 proteins were involved in the immune response,followed by 9 kinds of blood coagulation,4 transcripts,3 oxidative stress,3 growth factors and lipid metabolism 2 species.CONCLUSIONS: We isolated the porcine carotid artery intimal and dilated balloon to establish the model under microscope,through the imaging,pathology can simulate the occurrence of carotid dissection and the development of the situation.i TRAQ detected 58 proteins involved in carotid dissection,with 64% of the immune response proteins,and the side showed that the inflammatory response played an important role in the carotid dissection. |
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