Meyers Philip M, Schumacher H Christian, Tanji Kurenai, Higashida Randall T, Caplan Louis R
Columbia University College of Physicians & Surgeons, New York, New York 10032, USA.
Annu Rev Med. 2007;58:107-22. doi: 10.1146/annurev.med.58.121205.100631.
Intracranial atherosclerosis is a common cause of stroke. Although it has been recognized for decades, the lack of successful treatment strategies has limited clinical interest until recently. We review the natural history and pathophysiology of intracranial atherosclerosis. Vascular biomechanics are important to define differences between cerebral arteries and extracranial vessels and partly explain the technical challenges facing cerebral artery revascularization as compared with revascularization of coronary arteries. Pharmacological interventions to prevent stroke have had limited success, but technological developments offer improved methods for endovascular revascularization of symptomatic and asymptomatic cerebral artery stenosis. Identification of appropriate candidates for treatment also remains a challenge, and our knowledge about the natural history of the disease is limited. At this time, patients with significant intracranial stenosis should receive information on the benefits and risks of revascularization therapy. Determining which patients should undergo revascularization procedures will require carefully planned, randomized clinical trials.
颅内动脉粥样硬化是中风的常见病因。尽管几十年来一直为人们所认识，但直到最近，由于缺乏成功的治疗策略，临床关注度一直有限。我们回顾了颅内动脉粥样硬化的自然病史和病理生理学。血管生物力学对于界定脑动脉和颅外血管之间的差异很重要，并且部分解释了与冠状动脉血运重建相比，脑动脉血运重建所面临的技术挑战。预防中风的药物干预取得的成功有限，但技术发展为有症状和无症状脑动脉狭窄的血管内血运重建提供了改进方法。确定合适的治疗对象仍然是一项挑战，而且我们对该疾病自然病史的了解有限。此时，颅内严重狭窄的患者应了解血运重建治疗的益处和风险。确定哪些患者应接受血运重建手术将需要精心设计的随机临床试验。
