頸動脈夾層專業(yè)知識講座培訓課件

頸動脈夾層專業(yè)知識講座動脈夾層的定義動脈剝離(arterdissection)是血液進入動脈壁形成血腫或動脈壁內(nèi)自發(fā)性血腫,使血管壁間剝離,導致動脈管腔狹窄或血管破裂如果形成瘤樣突起，稱為夾層動脈瘤

(dissectinganeurysm)2頸動脈夾層專業(yè)知識講座動脈夾層模式圖TheNeurologist2008;14:66–733頸動脈夾層專業(yè)知識講座頸動脈夾層的模式圖NEnglJMed.200122;344(12):898-9064頸動脈夾層專業(yè)知識講座病例分享5頸動脈夾層專業(yè)知識講座病例分享6頸動脈夾層專業(yè)知識講座病例分享Neurosurgery.43(2):357-3597頸動脈夾層專業(yè)知識講座病例分享8頸動脈夾層專業(yè)知識講座病例分享9頸動脈夾層專業(yè)知識講座DSA常見征象10頸動脈夾層專業(yè)知識講座卒中或者TIA的發(fā)病機制栓子？血流動力學？11頸動脈夾層專業(yè)知識講座TCD栓子監(jiān)測TraumaticSpontaneousTotalNo.10717TCDEmboli6（60%）4（58%）10（59%）Stroke.1996;27:1226-123012頸動脈夾層專業(yè)知識講座影像學特點與發(fā)病機制Stroke.1998;29:2646-2648.13頸動脈夾層專業(yè)知識講座抗栓開始和結(jié)束的時間14頸動脈夾層專業(yè)知識講座局部癥狀和缺血的時間間隔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頸動脈夾層專業(yè)知識講座抗栓治療的時限動脈夾層最初3～6個月有再發(fā)卒中的風險6個月后很少再發(fā)16頸動脈夾層專業(yè)知識講座頸動脈夾層

抗凝vs抗血小板17頸動脈夾層專業(yè)知識講座19頸動脈夾層專業(yè)知識講座2008meta-analysisMedlineandPubMedweresearchedfrom1966to8April2007cervicalarterydissection34non-randomisedstudies762patientsJNNP,2008;79;1122-112720頸動脈夾層專業(yè)知識講座Outcome:StrokeJNNP,2008;79;1122-112721頸動脈夾層專業(yè)知識講座Outcome:TIA+StrokeJNNP,2008;79;1122-112722頸動脈夾層專業(yè)知識講座Outcome:Stroke+DeathJNNP,2008;79;1122-112723頸動脈夾層專業(yè)知識講座2008meta-analysisConclusions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;1122-112724頸動脈夾層專業(yè)知識講座AspirinvsanticoagulationincarotidarterydissectionNeurology?2009;72:1810–1815Prospectivelycollecteddatafrom298consecutivepatientswithsICAD，nonrandomizedAnticoagulation(n~96)AspirinProspectivelycollecteddataofconsecutivepatientswithsICAD(n~202)newcerebralischemiceventsOutcomeOutcomesymptomaticintracranialhemorrhagemajorextracranialbleeding25頸動脈夾層專業(yè)知識講座OutcomeNeurology?2009;72:1810–181526頸動脈夾層專業(yè)知識講座Conclusions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）27頸動脈夾層專業(yè)知識講座最大型的研究CADISS仍在進行中CADISSCervicalArteryDissectioninStrokeStudyprospectivemulticentrerandomisedcontrolledtrialinacute(within7daysofonset)carotidandvertebralarterydissectionIntracerebralarterydissectionisexcludedIntJStroke.2007Nov;2(4):292-628頸動脈夾層專業(yè)知識講座CADISS-DesignAntiplatelettherapyaspirin,dipyridamoleorclopidogrelaloneorindualcombinationAnticoagulationtherapyheparinfollowedbywarfarinaimingforanInternationalNormalisedRatio(INR)intherange2–3foratleast3monthsSamplesize-3000IntJStroke.2007Nov;2(4):292-629頸動脈夾層專業(yè)知識講座2011AHA二級預防指南（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

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