|
|
颅内动脉狭窄血管内治疗的现状及展望
|
Abstract:
颅内动脉粥样硬化性疾病及其导致的颅内动脉狭窄是全球卒中的主要原因之一，构成了持续的治疗挑战。在颅内动脉狭窄的患者中，那些存在血流动力学障碍的患者尽管接受药物治疗和危险因素控制，仍面临再次卒中的高风险。对于这些高危患者，重新建通供血不足的区域是最合理的治疗策略，然而在随机对照试验中，血管内治疗尚未显示出足够的安全性和有效性。诊断和治疗技术的进步重燃了对血管内治疗策略的关注，并有越来越多的证据支持进一步评估这些策略在特定患者群体中的治疗作用。本综述概述了当前和新兴的血管内治疗方法，并提出未来可能有前景的管理策略。
Intracranial atherosclerotic disease and resultant intracranial arterial stenosis constitute one of the leading causes of stroke globally, posing a persistent therapeutic challenge. Among patients with intracranial arterial stenosis, those with hemodynamic disturbances continue to face a high risk of recurrent stroke despite medical treatment and risk factor control. For these high-risk patients, revascularization of the hypoperfused territory is the most rational therapeutic strategy. However, in randomized controlled trials, endovascular therapy has yet to demonstrate sufficient safety and efficacy. Advances in diagnostic and therapeutic techniques have reignited interest in endovascular treatment strategies, with increasing evidence supporting further evaluation of these strategies’ therapeutic effects in specific patient populations. This review outlines current and emerging endovascular treatment approaches and proposes promising management strategies for the future.
| [1] | White, H., Boden-Albala, B., Wang, C., et al. (2005) Ischemic Stroke Subtype Incidence among Whites, Blacks, and Hispanics. Circulation, 111, 1327-1331. https://doi.org/10.1161/01.CIR.0000157736.19739.D0 |
| [2] | Wong, L.K.S. (2006) Global Burden of Intracranial Atherosclerosis. International Journal of Stroke, 1, 158-159. https://doi.org/10.1111/j.1747-4949.2006.00045.x |
| [3] | Wang, Y., Zhao, X., Liu, L., et al. (2014) Prevalence and Outcomes of Symptomatic Intracranial Large Artery Stenoses and Occlusions in China: The Chinese Intracranial Atherosclerosis (CICAS) Study. Stroke, 45, 663-669. https://doi.org/10.1161/STROKEAHA.113.003508 |
| [4] | Sangha, R.S., Naidech, A.M., Corado, C., et al. (2017) Challenges in the Medical Management of Symptomatic Intracranial Stenosis in an Urban Setting. Stroke, 48, 2158-2163. https://doi.org/10.1161/STROKEAHA.116.016254 |
| [5] | Song, X., Li, S., Du, H., et al. (2022) Association of Plaque Morphology with Stroke Mechanism in Patients with Symptomatic Posterior Circulation ICAD. Neurology, 99, e2708-e2717. https://doi.org/10.1212/WNL.0000000000201299 |
| [6] | Dubow, J.S., Salamon, E., Greenberg, E., et al. (2014) Mechanism of Acute Ischemic Stroke in Patients with Severe Middle Cerebral Artery Atherosclerotic Disease. Journal of Stroke and Cerebrovascular Diseases, 23, 1191-1194. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.10.015 |
| [7] | Wabnitz, A.M., Derdeyn, C.P., Fiorella, D.J., et al. (2019) Hemodynamic Markers in the Anterior Circulation as Predictors of Recurrent Stroke in Patients with Intracranial Stenosis. Stroke, 50, 143-147. https://doi.org/10.1161/STROKEAHA.118.020840 |
| [8] | Prabhakaran, S., Liebeskind, D.S., Cotsonis, G., et al. (2021) Predictors of Early Infarct Recurrence in Patients with Symptomatic Intracranial Atherosclerotic Disease. Stroke, 52, 1961-1966. https://doi.org/10.1161/STROKEAHA.120.032676 |
| [9] | Amin-Hanjani, S., Pandey, D.K., Rose-Finnell, L., et al. (2016) Effect of Hemodynamics on Stroke Risk in Symptomatic Atherosclerotic Vertebrobasilar Occlusive Disease. JAMA Neurology, 73, 178-185. https://doi.org/10.1001/jamaneurol.2015.3772 |
| [10] | Alexander, M.J. and Yu, W. (2023) Intracranial Atherosclerosis Update for Neurointerventionalists. Journal of NeuroInterventional Surgery, 16, 522-528. https://doi.org/10.1136/jnis-2022-019628 |
| [11] | Prabhakaran, S., Wells, K.R., Jhaveri, M.D., et al. (2011) Hemodynamic Changes Following Wingspan Stent Placement—A Quantitative Magnetic Resonance Angiography Study. Journal of Neuroimaging, 21, e109-e113. https://doi.org/10.1111/j.1552-6569.2009.00425.x |
| [12] | Guppy, K.H., Charbel, F.T., Corsten, L.A., et al. (2002) Hemodynamic Evaluation of Basilar and Vertebral Artery Angioplasty. Neurosurgery, 51, 327-334. https://doi.org/10.1097/00006123-200208000-00006 |
| [13] | Sundt, T.M., Smith, H.C., Campbell, J.K., et al. (1980) Transluminal Angioplasty for Basilar Artery Stenosis. Mayo Clinic Proceedings, 55, 673-680. |
| [14] | Clark, W.M., Barnwell, S.L., Nesbit, G., et al. (1995) Safety and Efficacy of Percutaneous Transluminal Angioplasty for Intracranial Atherosclerotic Stenosis. Stroke, 26, 1200-1204. https://doi.org/10.1161/01.STR.26.7.1200 |
| [15] | Mori, T., Mori, K., Fukuoka, M., et al. (1997) Percutaneous Transluminal Cerebral Angioplasty: Serial Angiographic Follow-Up after Successful Dilatation. Neuroradiology, 39, 111-116. https://doi.org/10.1007/s002340050376 |
| [16] | Serruys, P.W., De Jaegere, P., Kiemeneij, F., et al. (1994) A Comparison of Balloon-Expandable-Stent Implantation with Balloon Angioplasty in Patients with Coronary Artery Disease. The New England Journal of Medicine, 331, 489-495. https://doi.org/10.1056/NEJM199408253310801 |
| [17] | Fiorella, D. and Woo, H.H. (2007) Emerging Endovascular Therapies for Symptomatic Intracranial Atherosclerotic Disease. Stroke, 38, 2391-2396. https://doi.org/10.1161/STROKEAHA.107.482752 |
| [18] | Derdeyn, C.P., Chimowitz, M.I., Lynn, M.J., et al. (2014) Aggressive Medical Treatment with or without Stenting in High-Risk Patients with Intracranial Artery Stenosis (SAMMPRIS): the Final Results of a Randomised Trial. Lancet, 383, 333-341. |
| [19] | Zaidat, O.O., Fitzsimmons, B.F., Woodward, B.K., et al. (2015) Effect of A Balloon-Expandable Intracranial Stent vs Medical Therapy on Risk of Stroke in Patients with Symptomatic Intracranial Stenosis: The VISSIT Randomized Clinical Trial. JAMA, 313, 1240-1248. https://doi.org/10.1001/jama.2015.1693 |
| [20] | Fiorella, D., Derdeyn, C.P., Lynn, M.J., et al. (2012) Detailed Analysis of Periprocedural Strokes in Patients Undergoing Intracranial Stenting in Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS). Stroke, 43, 2682-2688. https://doi.org/10.1161/STROKEAHA.112.661173 |
| [21] | Miao, Z., Jiang, L., Wu, H., et al. (2012) Randomized Controlled Trial of Symptomatic Middle Cerebral Artery Stenosis: Endovascular versus Medical Therapy in A Chinese Population. Stroke, 43, 3284-3290. https://doi.org/10.1161/STROKEAHA.112.662270 |
| [22] | Gao, P., Wang, T., Wang, D., et al. (2022) Effect of Stenting Plus Medical Therapy vs Medical Therapy Alone on Risk of Stroke and Death in Patients with Symptomatic Intracranial Stenosis: The CASSISS Randomized Clinical Trial. JAMA, 328, 534-542. https://doi.org/10.1001/jama.2022.12000 |
| [23] | Zaidat, O.O., Klucznik, R., Alexander, M.J., et al. (2008) The NIH Registry on Use of the Wingspan Stent for Symptomatic 70-99% Intracranial Arterial Stenosis. Neurology, 70, 1518-1524. https://doi.org/10.1212/01.wnl.0000306308.08229.a3 |
| [24] | Fiorella, D., Levy, E.I., Turk, A.S., et al. (2007) US Multicenter Experience with the Wingspan Stent System for the Treatment of Intracranial Atheromatous Disease: Periprocedural Results. Stroke, 38, 881-887. https://doi.org/10.1161/01.STR.0000257963.65728.e8 |
| [25] | Chimowitz, M.I., Lynn, M.J., Derdeyn, C.P., et al. (2011) Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis. The New England Journal of Medicine, 365, 993-1003. https://doi.org/10.1056/NEJMc1111906 |
| [26] | Alexander, M.J., Zauner, A., Chaloupka, J.C., et al. (2019) WEAVE Trial: Final Results in 152 On-Label Patients. Stroke, 50, 889-894. https://doi.org/10.1161/STROKEAHA.118.023996 |
| [27] | Jiang, W.J., Xu, X.T., Jin, M., et al. (2007) Apollo Stent for Symptomatic Atherosclerotic Intracranial Stenosis: Study Results. American Journal of Neuroradiology, 28, 830-834. |
| [28] | The SSYLVIA Study Investigators (2004) Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): Study Results. Stroke, 35, 1388-1392. https://doi.org/10.1161/01.STR.0000128708.86762.d6 |
| [29] | Von Schoenfeldt, P., Krützelmann, A., Bu？meyer, M., et al. (2015) Elective Treatment of Intracranial Stenosis with the Balloon-Expandable Pharos Vitesse Stent: 30-Day Stroke Rate and Complications. Journal of Neurointerventional Surgery, 7, 188-193. https://doi.org/10.1136/neurintsurg-2013-011019 |
| [30] | M？hlenbruch, M.A., Pfaff, J., Herweh, C., et al. (2016) One-Pass Endovascular Treatment of Intracranial Atherosclerotic Stenosis with a Novel PTA Balloon and Self-Expanding Microstent. Neuroradiology, 58, 893-899. https://doi.org/10.1007/s00234-016-1716-8 |
| [31] | Hassan, A.E., Khalil, M., Desai, S., et al. (2023) Resolute Onyx Stent More Effective than Wingspan Stent at Preventing Procedural Complications and Long-Term Restenosis. Interventional Neuroradiology, 29, 691-695. https://doi.org/10.1177/15910199221104633 |
| [32] | White, T.G., Shah Koul, K.A., et al. (2024) The Resolute Onyx Drug Eluting Stent for Neurointervention: A Technical Series. Interventional Neuroradiology, 30, 14-21. https://doi.org/10.1177/15910199221084398 |
| [33] | Htay, T. and Liu, M.W. (2005) Drug-Eluting Stent: A Review and Update. Vascular Health and Risk Management, 1, 263-276. https://doi.org/10.2147/vhrm.2005.1.4.263 |
| [34] | Derdeyn, C.P., Fiorella, D., Lynn, M.J., et al. (2017) Nonprocedural Symptomatic Infarction and In-Stent Restenosis after Intracranial Angioplasty and Stenting in the SAMMPRIS Trial (Stenting and Aggressive Medical Management for the Prevention of Recurrent Stroke in Intracranial Stenosis). Stroke, 48, 1501-1506. https://doi.org/10.1161/STROKEAHA.116.014537 |
| [35] | Aoki, J. and Tanabe, K. (2021) Mechanisms of Drug-Eluting Stent Restenosis. Cardiovascular Intervention and Therapeutics, 36, 23-29. https://doi.org/10.1007/s12928-020-00734-7 |
| [36] | Wessely, R. (2010) New Drug-Eluting Stent Concepts. Nature Reviews Cardiology, 7, 194-203. https://doi.org/10.1038/nrcardio.2010.14 |
| [37] | McFadden, E.P., Stabile, E., Regar, E., et al. (2004) Late Thrombosis in Drug-Eluting Coronary Stents after Discontinuation of Antiplatelet Therapy. Lancet, 364, 1519-1521. https://doi.org/10.1016/S0140-6736(04)17275-9 |
| [38] | Chen, Y.W., Smith, M.L., Sheets, M., et al. (2007) Zotarolimus, A Novel Sirolimus Analogue with Potent Anti-Proliferative Activity on Coronary Smooth Muscle Cells and Reduced Potential for Systemic Immunosuppression. Journal of Cardiovascular Pharmacology, 49, 228-235. https://doi.org/10.1097/FJC.0b013e3180325b0a |
| [39] | Garcia-Touchard, A., Burke, S.E., Toner, J.L., et al. (2006) Zotarolimus-Eluting Stents Reduce Experimental Coronary Artery Neointimal Hyperplasia after 4 Weeks. European Heart Journal, 27, 988-993. https://doi.org/10.1093/eurheartj/ehi752 |
| [40] | Iqbal, J., Gunn, J. and Serruys, P.W. (2013) Coronary Stents: Historical Development, Current Status and Future Directions. British Medical Bulletin, 106: 193-211. https://doi.org/10.1093/bmb/ldt009 |
| [41] | Windecker, S., Latib, A., Kedhi, E., et al. (2020) Polymer-Based or Polymer-Free Stents in Patients at High Bleeding Risk. The New England Journal of Medicine, 382, 1208-1218. https://doi.org/10.1056/NEJMoa1910021 |
| [42] | Qureshi, A.I., Kirmani, J.F., Hussein, H.M., et al. (2006) Early and Intermediate-Term Outcomes with Drug-Eluting Stents in High-Risk Patients with Symptomatic Intracranial Stenosis. Neurosurgery, 59, 1044-1051. https://doi.org/10.1227/01.NEU.0000245593.54204.99 |
| [43] | Abou-Chebl, A., Bashir, Q. and Yadav, J.S. (2005) Drug-Eluting Stents for the Treatment of Intracranial Atherosclerosis: Initial Experience and Midterm Angiographic Follow-Up. Stroke, 36, e165-e168. https://doi.org/10.1161/01.STR.0000190893.74268.fd |
| [44] | Ye, G., Yin, X., Yang, X., et al. (2019) Efficacy and Safety of Drug-Eluting Stent for the Intracranial Atherosclerotic Disease: A Systematic Review and Meta-Analysis. Journal of Clinical Neuroscience, 59, 112-118. https://doi.org/10.1016/j.jocn.2018.10.118 |
| [45] | Jia, B., Zhang, X., Ma, N., et al. (2022) Comparison of Drug-Eluting Stent with Bare-Metal Stent in Patients with Symptomatic High-Grade Intracranial Atherosclerotic Stenosis: A Randomized Clinical Trial. JAMA Neurology, 79, 176-184. https://doi.org/10.1001/jamaneurol.2021.4804 |
| [46] | Hassan, A.E., Mohammaden, M.H., Rabah, R.R., et al. (2020) Initial Experience with the Next-Generation Resolute Onyx Zotarolimus-Eluting Stent in Symptomatic Intracranial Atherosclerotic Disease. Frontiers in Neurology, 11, Article 570100. https://doi.org/10.3389/fneur.2020.570100 |
| [47] | Stapleton, C.J., Chen, Y.F., Shallwani, H., et al. (2020) Submaximal Angioplasty for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis of Peri-Procedural and Long-Term Risk. Neurosurgery, 86, 755-762. https://doi.org/10.1093/neuros/nyz337 |
| [48] | Seyedsaadat, S.M., Yolcu, Y.U., Neuhaus, A., et al. (2020) Submaximal Angioplasty in the Treatment of Patients with Symptomatic ICAD: A Systematic Review and Meta-Analysis. Journal of Neurointerventional Surgery, 12, 380-385. https://doi.org/10.1136/neurintsurg-2019-015451 |
| [49] | Sun, X., Yang, M., Sun, D., et al. (2024) Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS): Protocol of a Prospective, Multicentre, Randomised, Controlled Trial. Stroke and Vascular Neurology, 9, 66-74. |
| [50] | Li, G., Qiao, H., Lin, H., et al. (2022) Application of Drug-Coated Balloons for Intracranial Atherosclerosis Disease: A Systematic Review. Clinical Neurology and Neurosurgery, 213, Article ID: 107065. https://doi.org/10.1016/j.clineuro.2021.107065 |
| [51] | Zhang, J., Zhang, X., Zhang, J., et al. (2020) Drug-Coated Balloon Dilation Compared with Conventional Stenting Angioplasty for Intracranial Atherosclerotic Disease. Neurosurgery, 87, 992-998. https://doi.org/10.1093/neuros/nyaa191 |
| [52] | Liebeskind, D.S., Cotsonis, G.A., Saver, J.L., et al. (2011) Collaterals Dramatically Alter Stroke Risk in Intracranial Atherosclerosis. Annals of Neurology, 69, 963-974. https://doi.org/10.1002/ana.22354 |
| [53] | Amin-Hanjani, S., Du, X., Rose-Finnell, L., et al. (2015) Hemodynamic Features of Symptomatic Vertebrobasilar Disease. Stroke, 46, 1850-1856. https://doi.org/10.1161/STROKEAHA.115.009215 |
| [54] | Derdeyn, C.P., Fiorella, D., Lynn, M.J., et al. (2013) Mechanisms of Stroke after Intracranial Angioplasty and Stenting in the SAMMPRIS Trial. Neurosurgery, 72, 777-795. https://doi.org/10.1227/NEU.0b013e318286fdc8 |
