颅内动脉粥样硬化性狭窄导致的急性大血管闭塞性缺血性卒中血管内治疗进展

Advances in endovascular treatment of acute ischemic stroke with large vessel occlusion caused by intracranial atherosclerotic stenosis

急性大血管闭塞性缺血性卒中(AIS-LVO)的早期血管内治疗,在过去几年取得了较大的发展。静脉溶栓和机械取栓成为急性缺血性卒中治疗的标准方案。对于颅内动脉粥样硬化性狭窄(ICAS)导致的AIS-LVO,多见于亚洲人群,目前尚无大型随机对照研究证实血管内治疗方案的有效性。由于其发病机制不同,单纯机械取栓效果不如心源性栓塞(CE),除支架取栓外往往需要局部动脉内抗血小板药物应用以及球囊扩张、支架置入等更为复杂的操作。另一方面,由于其慢性狭窄导致的缺血耐受,这类患者的术前评估和术后处理也不同于CE,组织窗评估可能更为重要。因此本文拟将ICAS导致的AIS-LVO血管内治疗进展作一总结。

The endovascular treatment of acute ischemic stroke with large vessel occlusion(AIS-LVO)has made epoch-making progress in the past few years.Intravenous thrombolysis and mechanical thrombectomy have become the standard treatment for acute ischemic stroke(AIS).AIS-LVO caused by intracranial atherosclerotic stenosis(ICAS)is common in Asia,and there is no large RCT study to confirm the effectiveness of mechanical thrombectomy.Because of the different pathogenesis,mechanical thrombectomy which was designed primarily for embolic occlusion,may not be an effective treatment for acute ischemic stroke caused by ICAS.Besides stent retriever thrombectomy,more complex techniques and operations such as local intra-arterial antiplatelet drugs,angioplasty,and rescue stenting are often needed in ICAS patients.On the other hand,due to the ischemic tolerance caused by chronic stenosis,the preoperative evaluation and postoperative management of these patients are different from those of CE,and the reversible ischemic tissue evaluation may be more important.Therefore,this article will summarize the progress of endovascular treatment related to AIS-LVO caused by ICAS.