颅内大动脉粥样硬化狭窄性脑梗死的病理生理机制研究进展

Advances in Different Pathophysiological Mechanisms of Ischemic Stroke Caused by Intracranial Atherosclerosis

颅内大动脉粥样硬化狭窄(ICAS)是缺血性脑卒中最常见的病因之一,其2年脑卒中复发率可超过20%,是一个非常严峻的问题。ICAS性脑梗死(ICAS-IS)的发病机制主要包括动脉-动脉栓塞、低灌注、穿支动脉闭塞。目前,针对ICAS脑卒中的不同发病机制的研究进展和复发率等预后情况研究尚有待进一步明确。文中介绍了ICASIS的不同发病机制、影像评估及其预后。基于MR-DWI的梗死模式是最常见的评估发病机制的影像学方法,但其并不完全等同于ICAS-IS的病理生理机制。近年来,其他影像学方法的发展加深了临床医生对ICAS-IS病理生理机制的认识和评估。综合多种影像学方法的研究表明,血流动力学受损或动脉-动脉栓塞机制导致的ICAS-IS同流域脑梗死复发率高于穿支动脉闭塞。对不同机制的ICAS-IS进行风险分层,目的是为了进行有针对性的治疗,进而改善患者预后,减少脑血管事件的复发。

Intracranial atherosclerotic stenosis(ICAS)is one of the common causes in ischemic stroke(IS).The recurrence rate of ICAS-IS is more than 20%,which is a severe problem.The pathophysiological mechanism of ICAS can be divided into three types:artery-to-artery embolism(A-A),hypoperfusion/hemodynamic compromise(HP),parent artery atherosclerosis occluding penetrating artery(POPA).At present,it is unknown how the different types of pathophysiological mechanisms in ICASIS result in different prognoses including progression or recurrence.This article reviewed the different pathophysiological mechanisms,imaging features and prognoses of ICAS-IS.It was found that infarction pattern according to DWI was the most common imaging method to estimate the mechanism,but it could not be equal to the actual pathophysiological mechanism.Recently some newly-occurred imaging methods had enhanced our comprehension of the pathophysiology.In combination of various imaging methods,it was shown that the prognosis of ICAS-IS was related to different mechanisms.The mechanism of HP or A-A resulted in a higher recurrence risk compared to POPA.The fundamental purpose of distinguishing the risk of different types of ICAS-IS is to take targeted treatment,which can improve its prognosis and reduce the recurrence of cerebrovascular events.