Aneurysm, Dissecting

FRIDAY, April 4, 2025 -- Cervical artery dissection (CeAD) incidence increased from 2005 to 2019, with the increase in admissions particularly high in older, Black, and Hispanic populations, according to a study published online April 2 in Neurology . Liqi Shu, M.D., from The Warren Alpert Medical School of Brown University in Providence, Rhode Island, and colleagues determined national trends in CeAD admissions and examined post-CeAD risk for ischemic stroke using data from the National Inpatient Sample (2005 to 2019), National Readmission Database (2015 to 2019), and State Inpatient Database for New York (2011 to 2017) and Florida (2011 to 2019). A total of 125,102 patients with spontaneous CeAD were identified from 2005 to 2019. The researchers observed an increase in CeAD incidence from 10.7 to 45.6 cases per million population from 2005 to 2019, with an average annual percent change (AAPC) of 10.21 percent. In the older, Black, and Hispanic populations, this increase in CeAD admissions was particularly high. The upward trend was corroborated in statewide data, with an AAPC of 8.47 percent. Vertebral artery dissection was the sole major predictor of subsequent ischemic stroke risk within 90 days among patients with CeAD without acute ischemic stroke (adjusted subdistributed hazard ratio, 1.77). Similar results were seen in interaction and subgroup analyses. "Our data highlight the importance of increased clinical vigilance to avert recurrent stroke, and future research should target the most efficacious treatment modalities for vertebral artery dissection," the authors write. Several authors disclosed ties to the biopharmaceutical and medical device industries.

THURSDAY, April 3, 2025 -- Strokes caused by an artery tear are landing five times as many Americans in the hospital these days, a new study says. Cervical artery dissection involves a small tear in the inner lining of an artery in the neck that supplies blood to the brain. Blood can clot at the site of the tear. If the clot breaks loose, it can travel to the brain and cause a stroke. Hospitalizations for this sort of stroke have increased nearly fivefold during the past 15 years, according to findings published April 2 in the journal Neurology . “Cervical artery dissection is an important cause of stroke, especially in people under 50, so it is crucial to detect it right away,” senior researcher Dr. Shadi Yaghi , a vascular neurologist at Brown University in Providence, R.I., said in a news release. “Strokes that are not fatal can lead to long-term disability, poor mental health and reduced quality of life,” he said. “Our research found a dramatic increase in the number of hospitalizations for cervical artery dissection, with rates rising steadily year over year.” These sort of tears in the cervical artery are most often caused by a motor vehicle crash or other accident that causes neck strain, researchers said. However, activities as simple as heavy lifting has been known to cause a cervical artery tear in some people. For the study, researchers analyzed 15 years of U.S. health data to identify more than 125,000 people hospitalized for cervical artery dissection. Patients had an average age of 51, and just over half suffered a stroke from their artery tear, results show. The number of artery tears increased about 10% a year on average, rising from 11 cases per million people in 2005 to 46 cases per million in 2019, results show. Men and women were equally at risk for suffering an artery tear, but there were differences between races. Cervical artery dissections increased by 16% a year on average among Hispanic people, compared to 13% for Black people, 12% for Asian people and 8% for white people. Seniors also have become more prone to these tears, with an average annual increase of 12% among people 65 and older compared to 8% for people under 65, researchers said. “Possible reasons for this nearly five-fold increase over 15 years include greater awareness of cervical artery dissection by health care professionals, better access to imaging to help identify it and an overall increase in this condition for which a cause has yet to be determined,” Yaghi said. “Given the rising incidence of cervical artery dissection, our study underscores the importance of finding prevention strategies as well as new treatments to reduce the risk of stroke,” he added. Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

引言 胸痛是临床常见症状之一，导致胸痛的病因复杂，病情的严重程度相差很大。对于高危患者，症状发作后启动治疗越早，疗效越好，获益越多。因此，急性胸痛患者的早期鉴别和危险分层，对于识别高危患者并给予及时正确的处置具有重要意义。 近期，我们邀请了来自重庆医科大学附属第一医院的蒲鹏教授，向我们阐述了急性胸痛的临床诊疗策略，本文将梳理精彩内容，以饕读者。 一、胸痛的认识 急性胸痛是急诊内科最常见的症状之一，急性胸痛的病因较多，病情千变万化，危险性存在较大差异。应尽早识别急性冠脉综合征（ACS）、主动脉夹层、肺栓塞、气胸、急性心肌心包炎等高危疾病，并给予及时、正确的处理。值得注意的是，实际上仅有15%~25%的急性胸痛是ACS可能。在处理急诊胸痛时，应积极寻找引起症状的其他病因，不应将胸痛视为ACS的特有症状，易造成误诊。 二、临床上如何快速诊断和鉴别诊断急性胸痛？ 诊断急性胸痛主要包括以下5大方面，分别为：症状、体征、心电图（ECG）、化验和影像学检查。关于胸痛的问诊，需询问患者的发病年龄、疼痛部位、疼痛性质、持续时间、诱因及缓解因素、伴随症状。胸痛部位不同，对应不同疾病，包括以下方面： 心前区疼痛：见于心绞痛、急性心肌梗死（AMI）、心包炎、心肌炎、夹层、主动脉瘤； 胸骨后疼痛：多见于心绞痛、急性心肌梗死、心包炎、心肌炎、食管疾病、纵隔疾病等； 后背痛：见于脊柱疾病、主动脉夹层动脉瘤、胰腺炎等； 左肩部放射痛：多见于心绞痛、急性心肌梗死、夹层动脉瘤； 上腹痛疼痛：见于胃部疾病、胰腺炎、心绞痛、心肌梗死等。 但应注意，上牙以下，肚脐以上的疼痛或任何不明原因的不适都应该警惕ACS可能，一定要行心电图检查。 三、急性胸痛的诊断思路 首先应迅速的询问病史、查体及辅助检查（ECG、胸片、心肌损伤标志物等），其次区分胸痛为高危或低危，区分胸痛为心源性或非心源性，应注意高危胸痛的识别是关键！高危胸痛特征为急、重、猛，高危胸痛可根据患者的表情、症状及体征等方面进行快速识别。 四、ACS的临床诊疗策略 1 10 min后完成首份心电图 心电图是早期快速识别ACS的重要工具，10 min内应完成首份12/18导联心电图检查。非ST抬高型急性冠脉综合征（NSTE-ACS）的心电图典型表现为至少2个相邻导联ST段压低≥0.1 mv或者T波改变，并呈动态变化；变异型心绞痛可表现为一过性ST段抬高；初始心电图正常，不能除外NSTE-ACS，如胸痛持续不缓解，需要每间隔5~10 min复查1次心电图。ST抬高型急性冠脉综合征（STEMI）的心电图表现为典型表现为2个或以上导联ST段弓背抬高；新发的左束支传导阻滞也提示STEMI；心电图表现为缺血相关导联的T波高耸提示为STEMI超急性期。 2 完善心肌损伤标志物的检测——肌钙蛋白（cTn） 当cTn升高，且至少1个值高于参考上限（URL）时，应使用“心肌损伤”一词。如果cTn值升高和/或降低，则考虑为急性心肌损伤。当存在急性心肌损伤且临床上有急性心肌缺血迹象，且检测到cTn值上升和/或下降，且至少1个值高于第99百分位URL，且至少1个值符合以下条件时，应使用“急性心肌梗死”一词： 缺血症状； 新发生的缺血性ECG改变； 病理性Q波形成； 影像学证据显示有新的心肌活性丧失或新发的局部室壁运动异常； 冠脉造影或尸检证实冠状动脉内有血栓。 3 药物治疗支持 溶栓治疗：对于STEMI患者，如无条件进行介入治疗，可给予溶栓药物如尿激酶、瑞替普酶等溶解血栓，恢复冠状动脉血流； 抗血小板治疗：给予阿司匹林、替格瑞洛等抗血小板药物，抑制血小板聚集，防止血栓形成和扩大； 镇痛治疗：对于胸痛剧烈的患者，可给予吗啡等镇痛药物缓解疼痛，减轻患者焦虑和恐惧情绪； 其他药物治疗：根据患者病情和医生建议，可给予其他相关药物治疗，如抗心律失常药物、降压药物等。 4 非药物治疗 心电监护：持续进行心电监护，密切观察患者心率、心律和血压等生命体征变化，及时发现和处理异常情况； 休息与饮食调整：患者需卧床休息，避免过度活动和情绪激动；同时调整饮食结构，以清淡易消化为主，保持大便通畅； 介入与外科手术治疗：对于有条件的医院和患者，可尽快进行急诊冠状动脉介入手术，实现血运重建； 吸氧及呼吸机治疗：对需要的患者给予吸氧及呼吸机支持，提高血氧饱和度，改善心肺状况。 5 心律失常监测及处理技巧 严密监测心电图：持续心电监护，及时发现心律失常； 准备抢救设备：备好除颤器、起搏器等抢救设备，以便随时进行抢救； 药物治疗：根据心律失常类型，选用适当的抗心律失常药物； 电复律治疗：对于严重心律失常，如室颤、室速等，应及时进行电复律治疗。 欢迎投稿：学术成果、前沿进展、临床干货等主题均可，点此了解投稿详情。 免责声明：药明康德内容团队专注介绍全球生物医药健康研究进展。本文仅作信息交流之目的，文中观点不代表药明康德立场，亦不代表药明康德支持或反对文中观点。本文也不是治疗方案推荐。如需获得治疗方案指导，请前往正规医院就诊。 分享，点赞，在看，传递医学新知