颈动脉夹层精选课件.ppt
关于颈动脉夹层第一页，本课件共有31页动脉夹层的定义动脉剥离(arter dissection)是血液进入动脉壁形成血肿或动脉壁内自发性血肿,使血管壁间剥离,导致动脉管腔狭窄或血管破裂如果形成瘤样突起，称为夹层动脉瘤(dissecting aneurysm)第二页，本课件共有31页动脉夹层模式图The Neurologist 2008;14:6673第三页，本课件共有31页颈动脉夹层的模式图N Engl J Med.2001 22;344(12):898-906第四页，本课件共有31页病例分享第五页，本课件共有31页病例分享第六页，本课件共有31页病例分享Neurosurgery.43(2):357-359第七页，本课件共有31页病例分享第八页，本课件共有31页病例分享第九页，本课件共有31页DSA常见征象第十页，本课件共有31页卒中或者卒中或者TIA的发病机制的发病机制栓子？血流动力学？第十一页，本课件共有31页TCD 栓子监测TraumaticSpontaneousTotalNo.10717TCD Emboli6（60%）4（58%）10（59%）Stroke.1996;27:1226-1230第十二页，本课件共有31页影像学特点与发病机制Stroke.1998;29:2646-2648.第十三页，本课件共有31页抗栓开始和结束的时间抗栓开始和结束的时间第十四页，本课件共有31页局部症状和缺血的时间间隔Time Interval Between First Local and Ischemic SignsStudyTIACompleted strokesFisher(1982)Mins to 5 mo1 hour to several weeksMean:2645 dMean:7.89 dHart and Easton(1983)Several hours or daysBiller(1986)A few hours to 7 days from trauma to symptomsMokri(1990)A few mins to 2 wksBiousseMins to 66 dMins to 31 dMean:10.513.5 dMean:56.5 dStroke.1995;26:235-239第十五页，本课件共有31页抗栓治疗的时限动脉夹层最初36个月有再发卒中的风险6个月后很少再发第十六页，本课件共有31页颈动脉夹层颈动脉夹层抗凝抗凝 vs 抗血小板抗血小板第十七页，本课件共有31页很多学者倾向于抗凝Stroke.2007;38:2605-2611第十八页，本课件共有31页第十九页，本课件共有31页2008 meta-analysisMedline and PubMed were searched from 1966 to 8 April 2007cervical artery dissectioncervical artery dissection34 non-randomised studies762 patientsJNNP,2008;79;1122-1127第二十页，本课件共有31页Outcome:StrokeJNNP,2008;79;1122-1127第二十一页，本课件共有31页Outcome:TIA+StrokeJNNP,2008;79;1122-1127第二十二页，本课件共有31页Outcome:Stroke+DeathJNNP,2008;79;1122-1127第二十三页，本课件共有31页2008 meta-analysis Conclusions对于颈动脉夹层的患者，没有证据支持抗凝治疗优于抗血小板治疗需要前瞻性的随机对照试验对比抗凝治疗和抗血小板治疗的有效性JNNP,2008;79;1122-1127第二十四页，本课件共有31页Aspirin vs anticoagulation in carotid artery dissectionNeurology 2009;72:18101815Prospectively collected data from 298 consecutive patients with sICAD，nonrandomizedAnticoagulation(n96)AspirinProspectively collecteddata of consecutive patients with sICAD(n202)new cerebral ischemic eventsOutcomeOutcomesymptomatic intracranial hemorrhagemajor extracranial bleeding第二十五页，本课件共有31页OutcomeNeurology 2009;72:18101815第二十六页，本课件共有31页Conclusions局限性：非随机的研究自发颈动脉夹层的患者其新发生的脑和视网膜缺血事件的发生频率较低新发事件与抗栓治疗的方法可能无关（抗凝 vs 抗血小板）第二十七页，本课件共有31页最大型的研究CADISS仍在进行中CADISSCervical Artery Dissection in Stroke Studyprospective multicentre randomised controlled trialin acute(within 7 days of onset)carotid and vertebral artery dissectionIntracerebral artery dissection is excludedInt J Stroke.2007 Nov;2(4):292-6 第二十八页，本课件共有31页CADISS-DesignAntiplatelet therapyaspirin,dipyridamole or clopidogrel alone or in dual combinationAnticoagulation therapyheparin followed by warfarin aiming for an International Normalised Ratio(INR)in the range 23 for at least 3 monthsSample size-3000Int J Stroke.2007 Nov;2(4):292-6 第二十九页，本课件共有31页2011 AHA 二级预防指南（总结）合并缺血性卒中或者TIA的颅外颈动脉或者椎动脉夹层的患者，抗栓治疗至少3-6个月(Class IIa;Level of Evidence B).合并缺血性卒中或者TIA的颅外颈动脉或者椎动脉夹层的患者，应该选择抗血小板治疗还是抗凝治疗还不清楚(Class IIb;Level of Evidence B)(New recommendation)Stroke,Jan 2011;42:227-276第三十页，本课件共有31页感谢大家观看第三十一页，本课件共有31页
