有症状的动脉网需要积极的干预
Clayton J Brinster1, James O'Leary1, Aaron Hayson1
1Vascular Surgery Section, Ochsner Health, New Orleans, LA.
Journal of vascular surgery
|September 8, 2023
概括
症状性 Carotid 网 (CaWeb) 是一种罕见的栓塞性中风的原因,经常被错误诊断. 积极的干预,而不是医疗管理,对于预防CaWeb患者的复发性中风至关重要.
科学领域:
- 血管神经学 血管神经学
- 干预性神经辐射学
- 脑血管疾病 脑血管疾病
背景情况:
- 冠状动脉网 (CaWeb) 是一种罕见的纤维肌力发育不良变体,与栓塞性中风有关.
- 误诊为密码性中风是常见的,导致潜在的破坏性复发事件.
- 关于CaWeb自然历史和最佳管理策略的文献有限.
研究的目的:
- 为了分析最大的单一机构队列的症状CaWeb患者.
- 为了评估成像模式的诊断准确性.
- 为了比较医疗与干预管理的结果.
主要方法:
- 定义CaWeb作为一个线性投影在动脉球,导致CTA/血管学上的填充缺陷.
- 在6年的时间里 (2016-2022年) 确定了52例有症状的CaWeb病例.
- 审查了初始呈现,诊断成像和管理结果 (医疗与手术/支架).
主要成果:
- 67%的患者是非洲裔美国人; 35%是50岁以下的非洲裔美国女性.
- 90%的患者出现中风;在94%的患者中,狭窄症<50%.
- 医疗管理导致19% (所有病例) 的中风复发,而干预措施显示38个月的随访期间没有术后中风.
结论:
- 冠状动脉双对于CaWeb诊断是不够的;CTA/血管学是必不可少的.
- 由于复发率高,对有症状的CaWeb无法接受医疗管理.
- 对有症状的CaWeb进行积极的干预方法可显著降低复发性中风风险.
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