Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment.
Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment.
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DOI：
10.1016/s1474-4422(13)70195-9
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发表时间：
2013-11
期刊：
影响因子：
48
通讯作者：
Chimowitz, Marc I.
中科院分区：
文献类型：
--
作者：
Holmstedt, Christine A.;Turan, Tanya N.;Chimowitz, Marc I.
颅内动脉粥样硬化是世界范围内卒中最常见的原因之一，并与卒中复发的高风险相关。治疗这种高危疾病的新治疗方法包括双重抗血小板治疗、危险因素的强化管理和血管内治疗。来自随机试验的早期数据表明，对于颅内主要动脉粥样硬化性狭窄的高危患者，积极的药物治疗比支架植入术更能预防复发性卒中。尽管如此，仍有一些亚组的患者尽管进行了积极的药物治疗，但仍处于卒中的高风险中。需要进一步的研究来确定这些高危亚组，并开发更有效的治疗方法。可用于识别高危患者的非侵入性血管成像方法包括磁共振血管造影（MRA）血流分数、定量MRA和动脉粥样硬化斑块的高分辨率MRI。未来临床试验考虑的替代疗法包括单纯血管成形术、间接外科旁路手术、缺血预处理和新的抗凝剂（直接凝血酶或Xa抑制剂）。
Intracranial atherosclerosis is one of the most common causes of stroke worldwide and is associated with a high risk of recurrent stroke. New therapeutic approaches to treat this high-risk disease include dual antiplatelet treatment, intensive management of risk factors, and endovascular therapy. Early data from randomised trials indicate that aggressive medical therapy is better than stenting for prevention of recurrent stroke in high-risk patients with atherosclerotic stenosis of a major intracranial artery. Nevertheless, there are subgroups of patients who remain at high risk of stroke despite aggressive medical therapy. Further research is needed to identify these high-risk subgroups and to develop more effective treatments. Non-invasive vascular imaging methods that could be used to identify high-risk patients include fractional flow on magnetic resonance angiography (MRA), quantitative MRA, and high-resolution MRI of the atherosclerotic plaque. Alternative therapies to consider for future clinical trials include angioplasty alone, indirect surgical bypass procedures, ischaemic preconditioning, and new anticoagulants (direct thrombin or Xa inhibitors).