颅内动脉粥样硬化性狭窄的治疗现状与未来  

Treatment of Intracranial Atherosclerotic Stenosis:Current Debates and Future Directions

作　　者：罗继昌 王韬 焦力群[1,2] LUO Jichang;WANG Tao;JIAO Liqun(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,China International Neuroscience Institute,Beijing 100053,China;Department of Interventional Radiology,Xuanwu Hospital,Capital Medical University,China International Neuroscience Institute,Beijing 100053,China)

机构地区：[1]中国国际神经科学研究所,首都医科大学宣武医院神经外科,北京100053 [2]中国国际神经科学研究所,首都医科大学宣武医院介入放射科,北京100053

出　　处：《协和医学杂志》2022年第6期907-914,共8页Medical Journal of Peking Union Medical College Hospital

基　　金：“十二五”国家科技支撑计划(2011BAI08B04);“十三五”国家科技支撑计划(2016YFC1301703)。

摘　　要：颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)是导致缺血性卒中最主要的病因之一,在亚洲人群中高发。自2011年美国主导的高质量随机对照研究结果发布以来,ICAS的治疗一直备受关注和争议。近期,首个基于中国人群的ICAS血管内治疗与药物治疗随机对照研究结果正式发布,证实血管内治疗不劣于药物治疗效果,对于药物难治性血流动力学障碍的ICAS患者,血管内治疗获益可能更大,从而使ICAS的治疗再次引起全球关注。基于此,本文针对ICAS的疾病特点、治疗现状和未来发展进行系统阐述,以期为临床提供借鉴和指导。期待未来通过更严格的管理,提高患者的依从性,进而减少卒中的复发率和死亡率。Intracranial atherosclerotic stenosis(ICAS)is a leading cause of ischemic stroke,especially in Asia.Since the publication of high-quality randomized controlled trials conducted by the United States in 2011,ICAS has been a subject of controversy and concerns.Recently,the results of a randomized controlled trial published in the leading international medical journal compare the effectiveness of endovascular treatment and medical treatment for ICAS in the Chinese population,which has reattracted public attention to this issue.Endovascular therapy is not inferior to medical treatment,and the benefits of endovascular therapy may be greater in drug-refractory patients with hemodynamic disorders.Therefore,this paper systematically discusses ICAS disease characteristics,treatment status,and future directions,suggesting that endovascular therapy may be of further benefit to drug-refractory patients with hemodynamic disorders,and stricter medical management and improved patient compliance will further reduce stroke recurrences and mortality.

关 键 词：颅内动脉粥样硬化性狭窄 药物治疗 血管内治疗 卒中 

分 类 号：R743.1[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]