Stroke Caused by Atherosclerosis of the Major Intracranial Arteries.
Stroke Caused by Atherosclerosis of the Major Intracranial Arteries.
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DOI：
10.1161/circresaha.116.308441
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发表时间：
2017-02-03
影响因子：
20.1
通讯作者：
Chimowitz MI
中科院分区：
文献类型：
--
作者：
Banerjee C;Chimowitz MI
本文旨在探讨颅内主要动脉粥样硬化性脑卒中的病理生理、诊断和治疗。通过使用检索词“颅内狭窄”和“颅内动脉粥样硬化”检索PubMed 1955年至2016年6月发表的相关研究，确定了综述的参考文献。检索了已发表的随机临床试验和既往发表的综述的参考文献部分，以获取其他参考文献。颅内动脉粥样硬化性疾病（ICAD）是卒中的一个非常普遍的原因，与卒中复发的高风险相关。与白人相比，它在黑人、西班牙裔和亚洲人中更为普遍。糖尿病、高血压、代谢综合征、吸烟、高脂血症和久坐的生活方式是与ICAD相关的主要可改变的危险因素。比较积极治疗（双重抗血小板治疗90天，随后阿司匹林单药治疗和血管危险因素的强化管理）与颅内支架植入术加积极药物治疗的随机临床试验表明，单独药物治疗更安全，更有效地预防卒中。因此，积极的医疗管理已成为有症状的ICAD患者的标准治疗。尽管如此，仍有一些亚组的患者尽管接受了积极的医疗管理，但仍处于卒中的高风险中。未来的研究应致力于建立临床、血清学和影像学生物标志物，以识别高危患者，评估新疗法的临床试验应集中在这些患者身上。
Our goal in this review is to discuss the pathophysiology, diagnosis and treatment of stroke caused by atherosclerosis of the major intracranial arteries. References for the review were identified by searching PubMed for related studies published from 1955 to June 2016 using search terms “intracranial stenosis” and “intracranial atherosclerosis”. Reference sections of published randomized clinical trials and previously published reviews were searched for additional references. Intracranial atherosclerotic disease (ICAD) is a highly prevalent cause of stroke that is associated with a high risk of recurrent stroke. It is more prevalent among blacks, Hispanics and Asians compared with whites. Diabetes, hypertension, metabolic syndrome, smoking, hyperlipidemia and a sedentary lifestyle are the major modifiable risk factors associated with ICAD. Randomized clinical trials comparing aggressive management (dual antiplatelet treatment for 90 days followed by aspirin monotherapy and intensive management of vascular risk factors) with intracranial stenting plus aggressive medical management have shown medical management alone to be safer and more effective for preventing stroke. As such, aggressive medical management has become the standard of care for symptomatic patients with ICAD. Nevertheless, there are subgroups of patients who are still at high risk of stroke despite being treated with aggressive medical management. Future research should aim to establish clinical, serologic, and imaging biomarkers to identify high-risk patients, and clinical trials evaluating novel therapies should be focused on these patients.