对于神经干预学家来说,内动脉样硬化的更新
Michael J Alexander1, Wengui Yu2
1Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA michael.alexander@cshs.org.
Journal of neurointerventional surgery
|June 9, 2023
概括
内动脉样硬化疾病 (ICAD) 的管理正在发展. 虽然积极的医疗管理是首选的,但内血管选择 (如支架) 对某些未能接受医疗治疗的患者提供了好处,降低了中风风险.
科学领域:
- 神经学 神经学
- 干预性神经辐射学
- 血管神经学 血管神经学
背景情况:
- 内动脉样硬化疾病 (ICAD) 管理正在通过改进的成像和内血管技术取得进展.
- 对症状性ICAD的内血管治疗使用在美国显著增加.
- 萨姆普里斯试验确定了积极的医疗管理 (AMM) 优于初始支架.
研究的目的:
- 更新神经干预学家在不断发展的ICAD管理策略.
- 为咨询患者提供基于证据的指导,以了解治疗的风险和益处.
- 审查ICAD医疗和内血管治疗的最新进展.
主要方法:
- 关于ICAD管理的最新研究和里程碑性试验的审查.
- 对内血管治疗结果的分析,包括支架和血管塑造.
- 在大血管封闭 (LVO) 血栓切除术中的救援疗法的评估.
主要成果:
- 尽管AMM优越,但在一些患者中,中风风险仍然很高.
- 在最近的研究中,内支架显示了周围手术并发症的减少.
- 在医学治疗失败后,支架可能有利于血液动力学损害或栓塞性中风的患者.
- 用药物涂层的气球和支架可能会降低支架内缩.
- 在ICAD的LVO血栓切除术中,救援支架显示出有希望的结果.
结论:
- 失败于医疗管理的ICAD患者可能受益于内支架.
- 新兴的内血管技术为复杂的ICAD病例提供了新的选择.
- 需要继续进行研究,以优化ICAD的治疗策略.
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