頸動脈夾層專業(yè)知識講座培訓(xùn)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(jìn)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(dǎo)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(jī)制栓子？血流動力學(xué)？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(xué)特點與發(fā)病機(jī)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(fēng)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(jī)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(jī)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(jìn)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(yù)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