椎动脉支架植入术治疗颈椎按摩后椎动脉夹层导致急性多发性脑梗死患者1例

doi:10.24920/004336

摘要/Abstract

摘要：

椎动脉夹层是一种引发年轻人缺血性中风的罕见病变。颈部按摩，尤其是不当的牵引手法，是导致椎动脉损害甚至夹层形成的常见原因之一。我们报告了1例32岁女性，颈部按摩后出现左侧椎动脉V4节段内膜剥离，引发急性多发性后循环缺血性脑梗死。我们在夹层部位急诊实施了椎动脉支架植入术。治疗后第二天，症状明显缓解。次年，患者恢复良好，未出现并发症或血管内再狭窄。

关键词: 椎动脉夹层, 急性缺血性卒中, 支架植入, 血管内治疗

Abstract:

Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people. Cervical massage, especially improper pulling manipulation, is a cause of vertebral artery dissection. We present a case of 32-year-old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage. She underwent emergency vertebral artery stent implantation at the site of the dissection. Symptoms were relieved the day after treatment. The patient recovered without adverse complications or endovascular restenosis in the following year.

Key words: vertebral artery dissection, acute ischemic stroke, stent implantation, endovascular therapy

Ying-Xue Cui, Chuan-Jin Song, Xue-Si Hou, Gui-Lin Liu, Xu Ji, Shao-Song Wang. Vertebral Artery Stenting for Acute Multiple Cerebral Infarctions Caused by Vertebral Artery Dissection After Massage: A Case Report[J].Chinese Medical Sciences Journal, 2024, 39(2): 149-154.

图/表 6

参考文献 22.

1.	Clark M, Unnam S, Ghosh S. A review of carotid and vertebral artery dissection. Br J Hosp Med (Lond) 2022; 83(4):1-11. doi: 10.12968/hmed.2021.0421. pmid: 35506728
2.	Ribbons T, Bell S. Neck pain and minor trauma: normal radiographs do not always exclude serious pathology. Emerg Med J 2008; 25(9):609-10. doi: 10.1136/emj.2007.050328. pmid: 18723722
3.	Umasankar U, Carroll TJ, Famuboni A, et al. Vertebral artery dissection: not a rare cause of stroke in the young. Age Ageing 2008; 37(3):345-6. doi: 10.1093/ageing/afn004. pmid: 18308696
4.	Gomez-Rojas O, Hafeez A, Gandhi N, et al. Bilateral vertebral artery dissection: a case report with literature review. Case Rep Med 2020; 25:2020:8180926. doi: 10.1155/2020/8180926.
5.	Engelter ST, Traenka C, Gensicke H, et al. Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial. Lancet Neurol 2021; 20(5):341-50. doi: 10.1016/s1474-4422(21)00044-2. pmid: 33765420
6.	Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50(12):e344-e418. doi: 10.1161/str.0000000000000211.
7.	Debette S, Grond-Ginsbach C, Bodenant M, et al. Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology 2011; 77(12):1174-81. doi: 10.1212/WNL.0b013e31822f03fc. pmid: 21900632
8.	Kobayashi H, Morishita T, Ogata T, et al. Extracranial and intracranial vertebral artery dissections: a comparison of clinical findings. J Neurol Sci 2016; 15:362:244-50. doi: 10.1016/j.jns.2016.01.062.
9.	Covello BR, Chukus A. Vertebral artery dissection: a pain in the neck. Cureus 2021; 13(1):e12985. doi: 10.7759/cureus.12985.
10.	Debette S, Compter A, Labeyrie MA, et al. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol 2015; 14(6):640-54. doi: 10.1016/s1474-4422(15)00009-5. pmid: 25987283
11.	Wang YM, Zhang YS, Sui BB, et al. Chinese specialist consensus on imaging diagnosis of intracranial arterial dissection. Chin J Neurosurg 2017; 3(4):224-37. doi: 10.1186/s41016-017-0095-2.
12.	Jung SC, Kim HS, Choi CG, et al. Quantitative analysis using high-resolution 3T MRI in acute intracranial artery dissection. J Neuroimaging 2016; 26(6):612-7. doi: 10.1111/jon.12357. pmid: 27173143
13.	Sikkema T, Uyttenboogaart M, Eshghi O, et al. Intracranial artery dissection. Eur J Neurol 2014; 21(6):820-6. doi: 10.1111/ene.12384. pmid: 24824740
14.	Ji B, Wang PY, Huang YQ, et al. Investigation of extracranial internal carotid and vertebral artery dissection after cervical spine manipulation. Ann Vasc Surg 2023; 100169:2772-878. doi: 10.1016/j.avsurg.2023.100169.
15.	Caplan LR. Dissections of brain-supplying arteries. Nat Clin Pract Neurol 2008; 4(1):34-42. doi: 10.1038/ncpneuro0683. pmid: 18199995
16.	Nadgir RN, Loevner LA, Ahmed T, et al. Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. Neuroradiology 2003; 45(5):311-4. doi: 10.1007/s00234-003-0944-x. pmid: 12692699
17.	Chakrapani AL, Zink W, Zimmerman R, et al. Bilateral carotid and bilateral vertebral artery dissection following facial massage. Angiology 2008; 59(6):761-4. doi: 10.1177/0003319707309653. pmid: 18388028
18.	Ke JQ, Yin B, Fu FW, et al. A case report of locked-in syndrome due to bilateral vertebral artery dissection after cervical spine manipulation treated by arterial embolectomy. Medicine (Baltimore) 2016; 95(5):e2693. doi: 10.1097/md.0000000000002693.
19.	Markus HS, Hayter E, Levi C, et al. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol 2015; 14(4):361-7. doi: 10.1016/s1474-4422(15)70018-9. pmid: 25684164
20.	Shibahara T, Yasaka M, Wakugawa Y, et al. Improvement and aggravation of spontaneous unruptured vertebral artery dissection. Cerebrovasc Dis Extra 2017; 7(3):153-64. doi: 10.1159/000481442. pmid: 29040967
21.	Pham MH, Rahme RJ, Arnaout O, et al. Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery 2011; 68(4):856-66. discussion 866. doi: 10.1227/NEU.0b013e318209ce03. pmid: 21242839
22.	Chinese Society of Neurology. Chinese Guidelines for the Diagnosis and Treatment of Cervical Artery Dissection 2015. Chin J Neurol 2015; 48(8):644-51. doi: 10.3760/cma.j.issn.1006-7876.2015.08.004.

References	Neck massage	Symptoms	Vessels	Cerebral infarction lesions	Treatment	Outcomes
Nadgir et al.^[16]	Chiropractic manipulation	Headache, ataxia, dysarthria, hypoesthesia	Left vertebral artery dissection	Right thalamus	Low-molecular-weight heparin	Hemianesthesia of left side remained after 1 month
Chakrapani et al.^[17]	Chiropractic manipulation	Neck pain, ptosis	Bilateral vertebral artery dissection	None	Warfarin, clopidogrel, aspirin	Improved after 4 weeks; recovered after 1 year of follow-up
Ke et al.^[18]	Chiropractic manipulation	Quadriplegia, facial and bulbar palsy, dyspnoea	Bilateral vertebral artery dissection	Bilateral pons	Emergency endovascular therapy	Hemiplegia of both sides remained after 27 days

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