| Abstract | Uvod: Disekcija krvnih žila vrata karakterizirana je naglim istezanjem, edemom te razdorom
stijenke arterije i pojavom krvarenja unutar stijenke arterije što može rezltirati infarktom
mozga. Uobičajena pojavnost je u mlađoj i populaciji srednjih godina s vrhom incidencije 50-
ih godina. Lokalizacije disekcije najčešće su u području najveće mobilnosti.
Svrha rada: Cilj istraživanja 23 pacijenta zahvaćenih disekcijom krvnih žila vrata jest spoznati
učestalost pojave nastalih disekcija, uzroke i predisponirajuće faktore. Opisati najčešću
simptomatologiju, pojavu infarkta mozga, provedenu dijagnostiku te način liječenja. Rezultati
su se usporedili s drugim provednim istraživanjima.
Ispitanici i metode: Istraživanje se odnosilo na analizu 23 pacijenta disekcije krvnih žila vrata
u trogodišnjem razdoblju od 1.1.2021. do 31.12.2023. na Klinici za neurologiju Kliničkog
bolničkog centra Rijeka. 13 pacijenata imalo je disekciju vertebralne arterije, a 10 pacijenata
disekciju karotidne arterije vrata.
Rezultati: S obzirom na dob i spol učestalost disekcija češća je u muškog spola (78,26%).
Prosječna starosna dob svih pacijenata zahvaćenih disekcijom iznosi 59 godina i 2 mjeseca.
Ukupno gledajući, 20 pacijenata od ukupno 23 imalo je spontani nastanak disekcije (86,96%),
a 3 pacijenta traumatsku podlogu nastanka (13,04%). Jedanaest pacijenata s disekcijom
vertebralne arterije rezultiralo je infarktom mozga, a 8 pacijenta s disekcijom karotidne arterije,
pri čemu je jedan pacijent preminuo. Vodeći simptomi disekcije vertebralne arterije su
vrtoglavica priustna u 5 pacijenata (38,46%) i hemipareza u 5 (38,46%). Pacijenti s disekcijom
karotidne arterije također pokazuju prevalenciju hemipareze prisutnu u 5 pacijenata (50%).
Najčešće korištena dijagnostička metoda je CTA. Kod disekcije vertebralne arterije korištena
je u 12 pacijenata (92,30%), a kod disekcije karotidne arterije u 9 pacijenata (90%). Analizom
pacijenata disekcije vertebralne arterije antiagregacijski lijekovi (84,61%) prednjače u malom
postotku u odnosu na antikoagulacijsku terapiju (76,92%). Svim pacijentima s disekcijom
karotidne arterije primijenjena je kombinirana antikoagulacijska i antiagregacijska terapija
(100%).
Zaključak: Istraživanje obuhvaća 23 pacijenta s disekcijom krvnih žila vrata. Prevalencija
disekcija odnosi se na muški spol (78,26%). 20 pacijenata je imalo spontani nastanak disekcije
(86,96%). 11 pacijenata imalo je hipertenziju kao vodeći čimbenik rizika (47,83%). Vodeća
simptomatologija obje skupine pacijenata je hemipareza, 5 pacijenata (38,46%) skupine
disekcija vertebralne arterije i 5 pacijenata disekcije unutarnje karotidne arterije (50%). Osim
hemipareze, pacijenti s disekcijom vertebralne arterije imaju vrtoglavicu kao vodeći simptom s
jednakom učestalošću (38,46%). 19 pacijenata rezultiralo razvojem infarkta (82,61%), a jedan
pacijent iz skupine disekcija unutarnje karotidne arterije je preminuo (4,35%). Dijagnostika
CTA korištena je u 21 pacijenta (91,30%), a MRA druga je po zastupljenosti primijenjena u 10
pacijenata (43,48%). Liječenje obje skupine disekcija većinom je provedeno sukladno
smjernicama dvojnom antiagregacijskom terapijom koja je slijedila kombinacije
antikoagulacijskih i antiagregacijskih lijekova uz dvoje bolesnika u kojih je prethodno učinjena
mehanička trombektomija sukladno smjernicama za liječenje moždanog udara. |
| Abstract (english) | Introduction: Dissection is characterized by the rupture of the first layer in contact with the
blood and the entry of blood between the layers of the artery wall, visible in the form of a
hematoma. In most cases, it results in brain infarction. The usual occurrence is in the younger
and middle-aged population with the peak incidence in the 50s. Localization of dissections are
most common in the area of greatest mobility.
Purpose: The aim of the study of 23 patients affected by dissection of blood vessels in the neck
is to find out the frequency of occurrence of dissections and their previous causes. Describe the
most common symptomatology, occurrence of brain infarction, performed diagnostics and
method of treatment. The results were compared with other conducted researches.
Subjects and methods: The research referred to the analysis of 23 patients with dissection of
blood vessels of the neck in a three-year period from January 1, 2021. until 31.12.2023. at the
Neurology Clinic of the Rijeka Clinical Hospital Center. 13 patients had dissection of the
vertebral artery, and 10 patients had dissection of the carotid artery of the neck.
Results: With regard to age and sex, the frequency of dissections is more common in men
(78.26%). The average age of all patients affected by dissection is 59 years and 2 months.
Overall, 20 patients out of a total of 23 had a spontaneous onset of dissection (86.96%), and 3
patients had a traumatic origin (13.04%). 11 patients with vertebral artery dissection resulted in
brain infarction. 8 patients with carotid artery dissection resulted in brain infarction, with one
patient dying. The leading symptoms of vertebral artery dissections are dizziness (38.46%) and
unilateral weakness (38.46%), the carotid artery also shows unilateral weakness (50%) as
leading. The most frequently used diagnostic method is CTA. In vertebral artery dissection, it
was used in 12 patients (92.30%), and in carotid artery dissection in 9 patients (90%). Analyzing
patients with vertebral artery dissection, antiplatelet drugs (84.61%) lead in a small percentage
compared to anticoagulation therapy (76.92%). All patients with carotid artery dissection
received anticoagulation and antiplatelet therapy (100%).
Conclusion: The research includes 23 patients with dissection of blood vessels of the neck. The
prevalence of dissections refers to the male gender (78.26%). 20 patients had spontaneous onset
of dissection (86.96%). 11 patients had hypertension as the leading risk factor (47.83%). The
leading symptomatology of both groups of patients is hemiparesis, 5 patients (38.46%) of the
vertebral artery dissection group and 5 patients of internal carotid carotid artery dissection
(50%). In addition to hemiparesis, patients with vertebral artery dissection have dizziness as the
leading symptom with equal frequency (38.46%). 19 patients resulted in the development of a
heart attack (82.61%), and one patient from the internal carotid artery dissection group died
(4.35%). Diagnostic CTA was used in 21 patients (91.30%), and MRA was the second most
frequently used in 10 patients (43.48%). The treatment of both groups of dissections mostly
focused on the use of a common combination of anticoagulation and antiplatelet drugs, of which
a small number of patients were previously exposed to the mechanical thrombectomy
procedure. |
