Large Artery Atherosclerotic Occlusive Disease.
Large Artery Atherosclerotic Occlusive Disease.
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DOI：
10.1212/con.0000000000000436
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发表时间：
2017-02-01
期刊：
影响因子：
--
通讯作者：
Cole, John W
中科院分区：
文献类型：
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作者：
Cole, John W
审查目的：颅外或颅内大动脉粥样硬化通常被认为是缺血性卒中和短暂性脑缺血发作的潜在病因。鉴于大动脉粥样硬化在普通人群中的高患病率，确定所识别的动脉粥样硬化病变是否是患者动脉粥样硬化的真正原因可能是困难的。在所有情况下，最佳地治疗每个患者以最大限度地减少未来中风风险是至关重要的。颅外或颅内大动脉粥样硬化可根据个体患者的病史、检查和解剖成像结果大致分为四种不同的临床情况：无症状和有症状的颅外颈动脉狭窄、颅内动脉粥样硬化和颅外椎动脉粥样硬化性疾病。这篇综述为临床医生评估和治疗此类patients.Recent发现提供了一个框架：强化药物治疗无症状颈动脉狭窄的卒中和死亡率较低。有证据表明，患有严重症状性颈动脉狭窄的患者应尽早接受颈动脉血运重建，并且使用颈动脉内膜切除术的卒中或死亡风险低于颈动脉支架植入术。具体到支架植入术，中风或死亡的风险在老年患者和女性中最大。通过持续的行为调整和强化药物治疗来持续优化血管危险因素是颅内和椎动脉起源动脉粥样硬化患者预防卒中的主要方法。概要：通过持续的行为调整和强化药物治疗来优化终身血管危险因素是降低大动脉粥样硬化患者未来卒中风险的关键因素。当考虑颈动脉狭窄的血运重建手术时，应仔细考虑患者的人口统计学资料、合并症以及围手术期卒中和死亡的风险。
PURPOSE OF REVIEW: Extracranial or intracranial large artery atherosclerosis is often identified as a potential etiologic cause for ischemic stroke and transient ischemic attack. Given the high prevalence of large artery atherosclerosis in the general population, determining whether an identified atherosclerotic lesion is truly the cause of a patient's symptomatology can be difficult. In all cases, optimally treating each patient to minimize future stroke risk is paramount. Extracranial or intracranial large artery atherosclerosis can be broadly compartmentalized into four distinct clinical scenarios based upon the individual patient's history, examination, and anatomic imaging findings: asymptomatic and symptomatic extracranial carotid stenosis, intracranial atherosclerosis, and extracranial vertebral artery atherosclerotic disease. This review provides a framework for clinicians evaluating and treating such patients.RECENT FINDINGS: Intensive medical therapy achieves low rates of stroke and death in asymptomatic carotid stenosis. Evidence indicates that patients with severe symptomatic carotid stenosis should undergo carotid revascularization sooner rather than later and that the risk of stroke or death is lower using carotid endarterectomy than with carotid stenting. Specific to stenting, the risk of stroke or death is greatest among older patients and women. Continuous vascular risk factor optimization via sustained behavioral modifications and intensive medical therapy is the mainstay for stroke prevention in the setting of intracranial and vertebral artery origin atherosclerosis.SUMMARY: Lifelong vascular risk factor optimization via sustained behavioral modifications and intensive medical therapy are the key elements to reduce future stroke risk in the setting of large artery atherosclerosis. When considering a revascularization procedure for carotid stenosis, patient demographics, comorbidities, and the periprocedural risks of stroke and death should be carefully considered.