Analysis Of Clinical Characteristics And Prognosis Of 36 Patients With Cervical Artery Dissection

Objective:This study collected clinical data and follow-up prognosis of patients with ischemic stroke caused by cervical artery dissection,summarized and analyzed their characteristics,and provided clinical data for early diagnosis and rational treatment of the disease.Methods: From October 2017 to October 2019,clinical and follow-up data were collected from 36 patients who were clinically diagnosed with ischemic stroke caused by cervical artery dissection in the General Hospital of Ningxia Medical University Cardiovascular and Cerebrovascular Hospital.Results: Among the 36 patients with cervical artery dissection,19(53%)had internal carotid artery dissection and 17(47%)had vertebral artery dissection.All 36 patients with cervical artery dissection had cerebral or retinal ischemic events.33 patients presented with cerebral infarction or retinal ischemia as their first symptom,the first presentation of 2 patients was head and neck pain.In another case,the first symptoms were only limited left upper limb movement and pain.Lateral limb movement disorders were mainly seen in internal carotid artery dissection,while dizziness was more common in vertebral artery dissection.The ultrasonic signs of cervical artery dissection can be "double-lumen sign" or "intimal flap",local lumen dilatation,lumen long segment stenosis or occlusion.The detection rate of cervical artery dissection by cervical vascular ultrasound for the first time in hospital was31% and the coincidence rate was 75.0%.The imaging findings of internal carotid artery dissection of head and neck CTA were mostly "double-lumen sign" or "intimal flap",which was mainly seen on two-dimensional planes.The findings of patients with vertebral artery dissection were mostly "flame sign",which was mostly found on three-dimensional planes."Flame sign" was more common in DSA,followed by "double lumen sign or endometrial valve" and "pearl sign".Among the 31 patients with cervical artery dissection who were treated with drugs after onset,55%(17 cases)were treated with dual antiplatelet therapy,and 45%(14 cases)were treated with anticoagulant therapy.During the treatment period,both the antiplatelet and anticoagulant groups had 1 case of cerebral ischemia symptom attack,and 1 case of anticoagulant group died after treatment.P value was 0.546 by chi-square test,indicating that there was no statistically significant difference between the two in the treatment of cervical artery dissection.Four patients received intravascular interventional therapy.Thirty-one patients with carotid artery dissection continued oral drug therapy outside the hospital,among which 28 were treated with antiplatelet therapy and 3were treated with anticoagulation.After 6 months follow-up,there were 22 cases of complete recanalization or reduced stenosis.No cerebral or retinal ischemic events occurred in the 4patients who underwent intravascular interventional therapy during the follow-up period,the stent was unobstructed and non-displaced from cervical vascular ultrasound.During the follow-up period,no new CAD vessels were found in 34 patients,and 32 patients had no cerebral or retinal ischemic events.In this study,among the 36 patients with cervical artery dissection,except for 2 patients who died in the hospital,the remaining 34 patients had lower mean NHISS and mRS score at the time of discharge and 6 months later than that at the time of admission.Recanalization was found between 7 days and 6 months after onset.Conclusion:1.Cervical artery dissection has a variety of clinical manifestations.If it can be diagnosed early and treated reasonably,the prognosis is generally good and the risk of recurrence is not high.2.Cervical vascular ultrasound has high feasibility and reliability in the evaluation of cervical artery dissection,has the advantages of fast and convenient,and can be used as the first choice for screening and follow-up of patients with dissection.3.Antiplatelet or anticoagulant therapy can reduce the occurrence of cerebral and retinal ischemic events in CAD patients.4.Endovascular interventional therapy is an effective treatment against CAD patients with failed thrombectomy or rapid disease progression.