症状性颅内动脉粥样硬化斑块的致病机制研究进展

Study Advances in Pathogenesis of Symptomatic Intracranial Atherosclerotic Plaques

卒中是我国人口死亡和致残的第一位原因,其中急性缺血性卒中占高达60%~80%。动脉粥样硬化造成的血管狭窄是缺血性卒中的重要原因。在我国,颅内动脉狭窄较颅外动脉狭窄多见,大脑中动脉、基底动脉等最易受累。但人们往往过多地在意血管狭窄程度致脑缺血的作用,而忽略了其他多种因素的作用,如斑块性质、斑块位置、侧支循环状况及血流动力学异常等。很多研究者认为,斑块的不稳定性可能比狭窄率更重要。也有研究者认为,血流动力学的改变是导致急性缺血性卒中发生的重要原因。本文将对这些致病机制的最新进展进行综述,希望可以加深对脑血管疾病的认识和理解,进一步指导治疗。

Stroke has become the first cause of death and disability in China, in which acute ischemic stroke accounts for 60%-80%. Vascular stenosis caused by atherosclerosis （AS） is an important cause of ischemic stroke. For the Chinese people, intracranial atherosclerotic stenosis is more common, and the most common stenotic vessels are middle cerebral artery and basilar artery. In the past, researchers tended to pay too much attention to the artery stenosis that caused ischemic stroke, and neglected the role of many other factors, such as characteristics of plaque, plaque location, collateral circulation status and hemodynamic abnormalities, etc. Many researchers believed that the plaque instability might be more important than the extent of stenosis. Many other researchers claimed that the change of hemodynamics was an important cause of acute ischemic stroke. This paper is to review the recent progress of these pathogenic mechanisms, aiming at deepening our acquaintance and comprehension of cerebral vascular disease, so as to provide further guidance in treatment.