The Clinical Features And Evaluate Therapy Analysis Of 29 Cases Of Cervicocerebral Arterial Dissection

Objective:To describe clinical features and evaluate therapy in case with Cervico-cerebral arterial dissection(CAD).Methods:Twenty-nine cases of CAD diagnosed by HR-MRI or DSA at the Second Affiliated Hospital of Zhejiang University Medical College from February 2013 to August 2016 were collected.The risk factors,clinical manifestations,imaging features,and treatment were summarized and analyzed.Followed up for 3 months and performed imaging examinations for review.Results:29 cases of CAD included 20 cases(69.00%)of internal carotid artery dissection(ICAD),9 cases(31.00%)of vertebral artery dissection(VAD).The analysis found that gender,neck massage history was related to ICAD and VAD.ICAD was more common in males(19 vs.3),and neck massage history(0 vs.2)was more common in VAD.The difference was statistically significant(p<0.05).The main manifestations of CAD patients were ischemic stroke(93.10%),and infarction was the most common in the middle cerebral artery(62.07%).There were 9 cases(31.03%)of headaches.HR-MRI examination revealed intramural hematoma in 24 cases(82.76%),of which 4 cases(13.80%)had intimal flap;DSA showed 2 cases(20.69%)of double cavity syndrome.Among 20 patients with ICAD,2 cases(10.00%)were treated with percutaneous balloon internal carotid balloon dilatation+ carotid artery stent implantation + aspirin combined with Plavix for dual antiplatelet therapy,1 case(5.00%)given rt-PA thrombolytic therapy,1 Case(5.00%)received thrombolysis after rt-PA thrombolysis,14 cases(70.00%)were treated withsingle antiplatelet therapyafter dual antiplatelet therapy for 3 months,and the remaining 2 cases(5.00%)were treated with single antiplatelet therapy.Of the 9 patients with VAD,5(55.56%)were treated with single antiplatelet therapy and dual antiplatelet therapy and the remaining 4(44.44%)were treated with single antiplatelet therapy.All patients had improved symptoms after 3 months of treatment.No new cerebrovascular events or death occurred.13 patients(44.83%)underwent CTA or HR-MRI reexamination to indicate revascularization or improvement,and the risk factors and treatment options were similar.There is no obvious correlation between revascularization.Conclusion:CAD may be related to gender and neck massage history.The main clinical manifestations are ischemic events and head and neck pain.DSA and HR-MRI are helpful for CAD diagnosis,mainly manifested as "double-lumen sign","line-like sign"and "intramural hematoma".The prognosis of CAD is better than that of other types of ischemic stroke.Early diagnosis and early treatment are important for revascularization and ischemic reperfusion.