多模态影像评估颈内动脉夹层致重度狭窄后快速自发再通1例报道A Case Report of Multimodal Imaging Evaluation of Rapid Spontaneous Recanalization in Severe Stenosis Due to Internal Carotid Artery Dissection

颈内动脉夹层（internal carotid artery dissection，ICAD）是中青年缺血性卒中的重要病因。本文报道1例ICAD致重度狭窄后早期快速自发完全再通的少见病例。患者男性，57岁，因“头痛2天”入院。长途驾驶后出现双侧太阳穴胀痛，无明显神经系统局灶体征，既往偏头痛史30年。头颅MRI示散在腔隙性脑梗死灶。颈动脉彩色多普勒超声联合经颅彩色多普勒超声示右侧颈内动脉低速单峰频谱、眼动脉血流反向，提示远段近全闭塞及侧支开放。CTA示右侧颈内动脉C1段重度狭窄。入院第14天DSA显示右侧颈内动脉C2、C3段双腔征，确诊为ICAD。予阿司匹林、氯吡格雷双联抗血小板及阿托伐他汀治疗。入院第15天复查，血流频谱完全恢复正常，头痛完全缓解。出院3个月后随访，患者已恢复正常工作，无不适。对于ICAD致重度狭窄但侧支循环良好的患者，在规范抗栓治疗下可采取保守策略。多模态影像的合理组合与阶梯式应用是避免过度介入、实现精准诊疗的关键。 Internal carotid artery dissection (ICAD) is an important cause of ischemic stroke in young and middle-aged adults. This article describes a rare case of early, rapid, and complete spontaneous recanalization following severe stenosis caused by ICAD. A 57-year-old male was admitted with a 2-day history of headache. He developed bilateral temple distension after prolonged driving, without focal neurological signs, and had a 30-year history of migraine. Brain MRI revealed scattered lacunar infarcts. Carotid color Doppler ultrasonography combined with transcranial color Doppler ultrasonography showed a low-velocity single-peak spectrum in the right internal carotid artery (ICA) and reversed ophthalmic artery flow, indicating distal near-occlusion with collateral opening. CTA demonstrated severe stenosis of the right ICA C1 segment. On day 14 of admission, DSA revealed a double-lumen sign in the right ICA C2-C3 segments, confirming the diagnosis of ICAD. He was treated with dual antiplatelet therapy (aspirin plus clopidogrel) and atorvastatin. On day 15 of admission, repeat carotid ultrasound showed complete normalization of flow spectra and complete resolution of headache. At 3-month follow-up, the patient had returned to work and remained asymptomatic. For patients with severe stenosis due to ICAD but with adequate collateral circulation, a conservative strategy under standard antithrombotic therapy is feasible. The judicious combination and stepwise application of multimodal imaging are key to avoiding over-intervention and achieving precision management.