放射性双侧颈动脉闭塞性血管病中的颈动脉残端综合征
本文报道一例51岁鼻咽癌放疗后10年出现卒中综合征的男性患者，影像学显示双侧颈总动脉、左侧颈内动脉及右侧锁骨下动脉闭塞，闭塞血管近端呈锥形残端，CTA MIP及VRT显示经甲状颈干和颈升动脉的侧支循环。结论提示头颈部放疗与放射性血管病及缺血事件风险显著增加相关，颈动脉残端综合征应作为复发性卒中的罕见但严重病因考虑。
要点
- 头颈部放疗后多年出现卒中症状者，需警惕放射性颈动脉闭塞性血管病。
- CTA MIP及VRT可清晰显示闭塞血管的锥形残端及经甲状颈干/颈升动脉的侧支通路。
- 颈动脉残端综合征是复发性卒中的罕见但严重病因，阅片时应主动评估残端。
核心结论
- 头颈部肿瘤放疗与放射性血管病及脑血管缺血事件的发生率显著增加相关。
- 颈动脉残端综合征应被视为复发性卒中和卒中样症状的罕见但严重病因。
研究设计与样本
- 本文为个案报道并复习影像学表现，对象为1例51岁男性鼻咽癌患者，入院前10年接受放疗。
- 影像检查方法包括CT血管成像（CTA）的最大密度投影（MIP）和3D容积渲染技术（VRT）。
关键影像表现/征象
- 双侧颈总动脉、左侧颈内动脉及右侧锁骨下动脉闭塞，闭塞血管近端呈锥形「残端」。
- CTA MIP和VRT显示闭塞动脉经甲状颈干和颈升动脉形成侧支循环。
临床应用与阅片要点
- 对头颈部放疗史患者出现卒中症状时，阅片应重点观察颈动脉及锁骨下动脉有无闭塞及锥形残端。
- 利用CTA MIP和VRT重建评估侧支循环通路（甲状颈干、颈升动脉），辅助解释缺血机制。
局限性
- 本文为单个病例报道，样本量小，结论推广受限。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: To document the occurrence of radiation-induced vasculopathy as a delayed complication in the treatment of head and neck cancers.
METHODS: We present the case history and review the imaging findings in a 51-year-old man with a history of nasopharyngeal cancer, treated with radiotherapy 10 years prior to admission, who presented with a stroke syndrome. The pathophysiology, clinical and imaging features, and development of collateral pathways due to radiation-induced vasculopathy are discussed.
RESULTS: The patient had occlusion of the right and left common carotid arteries, as well as of the left internal carotid artery and the right subclavian artery. The proximally occluded vessels ended in tapered "stumps". CT angiography with Maximum Intensity Projection (MIP) and 3D Volume Rendering Technique (VRT) displayed the collateralisation of the occluded arteries via the thyrocervical trunks and ascending cervical arteries.
CONCLUSION: Radiation therapy for head and neck cancer is associated with a significantly increased incidence of radiation-induced vasculopathy and cerebrovascular ischaemic events. Carotid stump syndrome should be considered as a rare but serious cause of recurrent stroke and stroke-like symptoms.
引用
- Liew XY, Orr C, Dharsono F, et al. Carotid stump syndrome in radiation-induced bilateral carotid occlusive vasculopathy. Neuroradiology. 2026. PMID: 42089954. doi:10.1007/s00234-026-04017-5
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。