| Objective: Through the analysis of intracranial artery dissection in patients with clinical characteristics,to provide the reference for the clinical diagnosis and treatment of intracranial arterial dissection(IAD).Method: twenty-two cases of IAD who diagnosed in Guangxi Medical University of First Affiliated Hospital during August 2015 to December 2017 by CTA or DSA were collected and retrospectively reviewed.All of the imaging data were Collected,and clinic manifestations of each patient,treatment methods,complications,outcome of therapy and clinical followup were analyzed.Result : 22 cases of IAD includeds cases of 6 internal carotid dissection(ICD)(27.27%),8 cases of vertebral artery dissection(VAD)(36.36%),8 cases of basilar artery dissection(36.36%).These patients' average age(52.7±17.7)years old.There were 3 females(13.64%)and 19 males(86.36%).7 cases had Dizziness(31.82%),7 cases had headache(31.82%),There were 3 patients had ischemic stroke(13.63%),5 patients had subarachnoid hemorrhage(SAH)(22.72%),Among them,vertebral basilar artery dissection accounted for 4 cases,with a relative ratio of 1:4.1 case had epistaxis(4.55%).1 had a history of head and neck trauma before onset,and 1 was asymptomatic.One patient had headache and neck pain at the same time.Two patients had headache and ischemic stroke at the same time.Imaging feature: 8 cases of arterial dissection(36.36%),14 cases of dissecting aneurysm(63.64%).There were 10 typical imaging of CTA,including 7 cases(70%)showed dissecting aneurysm,2 cases(20%)showed luminal occlusion,1 case(10%)showed irregular stenosis.17 cases had typical imaging of DSA,5 cases showed irregular segment ectasia and irregular stenosis(29.41%).With the expansion of the outer diameter of 5 cases(29.41%),a huge placeholder in 1 case(5.88%),irregular stenosis in 1 case(5.88%),interna valve in 4 case(23.52%),1 case showed beaded levy(5.88%).Treatment: 5 patients(22.7%)received antiplatelet aggregation therapy,and 2 patients received dual antiplatelet aggregation therapy.Anticoagulation combined with antiplatelet aggregation in 2 cases(9.09%),5 cases had coil embolization with stent assistant(22.7%),1 had simple coil embolization(4.54%),4 cases had stent therapy(18.18%),4 had no therapy(18.18%),and 1 was dead(4.54%).A total of 10 patients received interventional therapy.One patient with basilar artery dissecting aneurysm had ischemic Stroke postoperatively who received stent-assisted coil embolization.No other patients had significant intraoperative or postoperative complications.Follow-up 3 months.7 cases showed no recurrence after imaging review,1 case was lost to follow-up,and 9 cases had relieve after interventional therapy.8 were treated with drugs and 4 had no therapy.There were no new cerebrovascular events during the follow-up period in patients who received drug therapy,and clinical and imaging follow-up was satisfactory.In addition to the 4 untreated patients,18 patients had improved clinical symptoms after 3 months of follow-up.There was a statistically significant difference in mRS scores before and after treatment(P<0.05).Conclusion : 1.The clinical manifestations of intracranial arterial dissection are non-specific and can manifest as dizziness,headache,or symptoms associated with cerebral infarction or subarachnoid hemorrhage.And the most common symptoms are headache.2.The dissection of the intracranial segment of the vertebral artery and the basilar artery are probably more than the intracranial segment of the internal carotid artery,and subarachnoid hemorrhage is more likely to occur.3.The diagnosis of intracranial arterial dissection mainly depends on the characteristic imaging features,especially CTA and DSA multimodality imaging.4.The treatment of intracranial arterial dissection should be individualized.it should choose drug therapy or drug combination interventional therapy depending on the specific manifestations of the patients,drug treatment or drug combination interventional therapy. |
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