Stroke：颈内动脉与椎动脉夹层表现明显不同

颈内动脉与椎动脉夹层的对比研究情况尚不明确，von Babo M等人比较了自发性颈内动脉夹层(sICAD)与自发性椎动脉夹层(sVAD)之间的潜在危险因素、临床症状、延迟诊断以及3个月的预后情况，发表在新一期的Stroke杂志上。
该对比研究比较分析了3所大学附属医院sICAD (n=668) 和sVAD (n=302)病人。
sICAD病人年龄更大(46.3±9.6 vs 42.0±10.2岁; P<0.001)，男性更多见(62.7%vs 53.0%; P=0.004)，更常见耳鸣症状(10.9% vs3.4%; P<0.001)，发生缺血性卒中更严重(NIHSS中位数：10±7.1 vs 5±5.9; P<0.001)。sVAD病人更多见双侧夹层(15.2% vs 7.6%; P<0.001)，吸烟者多发(36.0%vs 28.7%; P=0.007)，雷击样头痛(9.2% vs3.6%; P=0.001)和颈痛(65.8% vs33.5%; P<0.001)更普遍，更易发生蛛网膜下腔出血(6.0% vs0.6%; P<0.001)和缺血性卒中事件(69.5% vs52.2%; P<0.001)。经多因素分析后，性别差异无显著性(P=0.21)，其他所有变量仍具有显著差异。sICAD和sVAD的诊断时间相似，而且2001-2012较之前10年有所改善(8.0±10.5天vs 10.7±13.2天; P=0.004)。sVAD病人的缺血性卒中3个月的预后相对良好(mRS0-2：88.8% vs 58.4%; P<0.001)，3个月内再发TIA(4.8% vs 1.1%; P=0.001)缺血性卒中(2.8% vs0.7%; P=0.02)更常见。
sICAD和sVAD病人在很多方面表现出差异，未来的研究应该将这两个独立疾病分别分析。
与颈内动脉相关的拓展阅读：

• Neural Regen Res.：碱性成纤维细胞生长因子基因转染修复颈内动脉瘤壁
• JAMA：静脉溶栓可能是急性颈内动脉闭塞患者的首选
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Differences and Similarities Between Spontaneous Dissections of the Internal Carotid Artery and the Vertebral Artery (Revision 2).
BACKGROUND AND PURPOSE
To compare potential risk factors, clinical symptoms, diagnostic delay, and 3-month outcome between spontaneous internal carotid artery dissection (sICAD) and spontaneous vertebral artery dissection (sVAD).
METHODS
We compared patients with sICAD (n=668) and sVAD (n=302) treated in 3 university hospitals.
RESULTS
Patients with sICAD were older (46.3±9.6 versus 42.0±10.2 years; P<0.001), more often men (62.7% versus 53.0%; P=0.004), and presented more frequently with tinnitus (10.9% versus 3.4%; P<0.001) and more severe ischemic strokes (median National Institutes of Health Stroke Scale, 10±7.1 versus 5±5.9; P<0.001). Patients with sVAD had more often bilateral dissections (15.2% versus 7.6%; P<0.001) and were more often smokers (36.0% versus 28.7%; P=0.007). Thunderclap headache (9.2% versus 3.6%; P=0.001) and neck pain were more common (65.8% versus 33.5%; P<0.001) in sVAD. Subarachnoid hemorrhage (6.0% versus 0.6%; P<0.001) and ischemic stroke (69.5% versus 52.2%; P<0.001) were more frequent in sVAD. After multivariate analysis, sex difference lost its significance (P=0.21), and all other variables remained significant. Time to diagnosis was similar in sICAD and sVAD and improved between 2001 and 2012 compared with the previous 10-year period (8.0±10.5 days versus 10.7±13.2 days; P=0.004). In sVAD, favorable outcome 3 months after ischemic stroke (modified Rankin Scale, 0-2: 88.8% versus 58.4%; P<0.001), recurrent transient ischemic attack (4.8% versus 1.1%; P=0.001), and recurrent ischemic stroke (2.8% versus 0.7%; P=0.02) within 3 months were more frequent.
CONCLUSIONS
sICAD and sVAD patients differ in many aspects. Future studies should perform separate analyses of these 2 entities.