脑动脉夹层流行病学、临床诊断及治疗研究新进展

Epidemiological Characteristics, Diagnosis, Treatment and New Research Progress of Cerebral Artery Dissection

摘要: 脑动脉夹层是指动脉内膜撕脱引起血液流入血管壁内从而形成壁内血肿，并且当血肿累及内膜、中膜时，将会造成血管发生狭窄或闭塞；如果血液进入血管外膜时，则会形成夹层动脉瘤，当夹层动脉瘤发生破裂后，则会引起蛛网膜下腔出血(SAH)。脑动脉夹层(CAD)虽然不是临床上常见的疾病，但它却是青年脑卒中的重要原因，占45岁以下缺血性脑卒中的20.0%，其受累血管主要包括：颈内动脉系统、椎基底动脉系统。患者发病后临床表现为疼痛、局部症状以及脑血管供血区的缺血或出血症状。目前，临床上对于脑动脉夹层的治疗主要包括：药物治疗、血管内治疗、外科治疗等，但是患者选择何种治疗方法缺乏统一的标准。因此，本课题将以脑动脉夹层为起点，分析脑动脉夹层流行病学特点、临床诊断及治疗情况，为脑动脉夹层治疗提供依据和参考。

Abstract: Cerebral arterial dissection means that the dissection of arterial intima causes the blood to flow into the blood vessel wall to form a subintimal hematoma. When the hematoma is involved in the intima and media, the vessel will be stenosed or occluded. When blood enters the adventitia, dissecting aneurysm is formed. It will cause subarachnoid hemorrhage (SAH) when the dissecting aneurysm ruptures. The cerebral artery dissection (CAD) is not a common clinical disease, but it is an important cause of stroke in young people, accounting for 20% of ischemic stroke under the age of 45. The main vascular involvements include internal carotid artery system and vertebro-basilar system. Clinical manifestations of patients after the onset present with pain, local symptoms and ischaemia or bleeding symptoms of cerebral blood supply region. At present, the treatments of cerebral artery dissection include drug treatment, endovascular therapy, surgery, etc., but the selection of treatment still lacks a uniform standard. Therefore, this review will take the cerebral artery dissection as a starting point to analyze the epidemiological features, clinical diagnosis and treatment of cerebral arterial dissection, to provide the reference for the treatment of cerebral artery dissection.