症状性非急性期大脑中动脉粥样硬化性闭塞治疗的研究进展  

Research progress in treatment of symptomatic non-acute middle cerebra artery arteriosclerosis occlusion

作　　者：黄晨阳 刘廷钰 朱青峰 Huang Chenyang;Liu Tingyu;Zhu Qingfeng(The Second Clinical Medical College Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Neurosurgery,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二临床医学院,太原030001 [2]山西医科大学第二医院神经外科,太原030001

出　　处：《中国综合临床》2025年第2期155-160,共6页Clinical Medicine of China

基　　金：山西省重点研发计划(201603D321061)。

摘　　要：非急性期大脑中动脉粥样硬化性闭塞侧支循环代偿不良时,可引起明显的神经功能障碍和较高的卒中复发率,传统的治疗方法以控制危险因素、药物对症治疗为主,但效果不尽如人意。近年来,随着血管内介入技术、介入材料和神经外科显微吻合技术的发展,以及远端缺血调节概念的提出,非急性期大脑中动脉粥样硬化性闭塞的治疗受到更多关注。对于症状性非急性期大脑中动脉粥样硬化性闭塞(symptomatic non-acute middle cerebra artery arteriosclerosis occlusion,SNMCAO)的手术治疗,颞浅动脉-大脑中动脉(superficial temporal artery middle cerebral artery,STA-MCA)低流量搭桥术与血管内介入再通术各有优势。对于预计闭塞时间短、闭塞节段短、血管平直、远端血管床较好的患者,可能更倾向于血管内再通治疗,反之则选择STA-MCA低流量搭桥术。无论选择哪种治疗方式,术前一定要做到精准的个体化评估,选择个体化的手术方式,才能使SNMCAO患者最大程度地获益。In the non-acute phase,when the collateral circulation is poorly compensated due to atherosclerotic occlusion of the middle cerebral artery,it can lead to significant neurological dysfunction and a higher recurrence rate of stroke.Traditional treatments primarily involve managing risk factors and administering symptomatic pharmacotherapy,yet the outcomes are often unsatisfactory.In recent years,with the development of endovascular interventional techniques and interventional materials,microsurgical anastomosis,techniques,and the present of distal ischemic modulation,the treatment of symptomatic arteriosclerosis occlusion of the non-acute middle cerebral artery is attracting more and more attention in the field.This article reviews the progress of the treatment of symptomatic arteriosclerosis occlusion of the non-acute middle cerebral artery.For the surgical treatment of symptomatic non-acute middle cerebral artery atherosclerosis occlusion(SNMCAO)in non-acute phase,the superior temporal artery middle cerebral artery(STA-MCA)low flow bypass and intravascular interventional recanalization have their own advantages.For patients with short expected occlusion time,short occlusion segment,straight blood vessels,and good distal vascular bed,they may be more inclined to undergo endovascular recanalization treatment,otherwise they may choose STA-MCA low flow bypass surgery.Regardless of which treatment method is chosen,precise individualized evaluation must be conducted before surgery to select an individualized surgical approach that can maximize the benefits for patients with SNMCAO.

关 键 词：大脑中动脉粥样硬化性闭塞 血管内介入 颅内外动脉搭桥手术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]