Mazighi Mikael, Abou-Chebl Alex
Interventional Neurology, Department of Neurology, University of Louisville, School of Medicine, Louisville, Kentucky, USA.
Curr Drug Targets. 2007 Jul;8(7):867-73. doi: 10.2174/138945007781077445.
Stenting for the prevention of atherosclerosis related ischemic strokes is a recent option in the therapeutic armamentarium. For extracranial carotid artery stenosis, stenting has proven its benefit in patients defined as "high-risk" for surgery, but beyond this specific population, surgery remains the gold standard. Based on recent prospective randomized trials, carotid endarterectomy (CEA) and carotid artery stenting (CAS) seem to share equivalent peri-procedural stroke risks, but the significantly higher rates of local nerve injury and myocardial infarction related to the surgical approach should favor the endovascular intervention in the future. In other locations, such as extracranial vertebral artery or intracranial stenoses, the current practice of care is not defined and the benefit of stenting is under investigation. However, in patients with symptomatic lesions despite appropriate antithrombotic therapy, stenting is considered to have a better benefit/risk profile in comparison to intracranial bypass surgery. In-stent restenosis (ISR), a major concern after stenting in coronary arteries, is an infrequent event following cervical internal carotid stenting but is relatively common and may worsen outcomes following treatment of extracranial vertebral and intracranial arterial stenoses. Drug eluting stents have proven their efficacy to control ISR and have changed dramatically the landscape of interventional cardiology, for this purpose their evaluation is now starting in the cerebral vasculature. The field of endovascular interventions is rapidly evolving and the development of devices dedicated to the cerebral vasculature is without any doubt going to extend the spectrum of treatable lesions.
支架置入术用于预防动脉粥样硬化相关的缺血性卒中是治疗手段中的一种新选择。对于颅外颈动脉狭窄，支架置入术已在被定义为手术“高风险”的患者中证明了其益处，但在这一特定人群之外，手术仍然是金标准。基于近期的前瞻性随机试验，颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）在围手术期的卒中风险似乎相当，但与手术方法相关的局部神经损伤和心肌梗死发生率显著更高，这在未来应更有利于血管内介入治疗。在其他部位，如颅外椎动脉或颅内狭窄，目前的治疗方法尚未明确，支架置入术的益处正在研究中。然而，对于尽管进行了适当的抗血栓治疗仍有症状性病变的患者，与颅内搭桥手术相比，支架置入术被认为具有更好的效益/风险比。支架内再狭窄（ISR）是冠状动脉支架置入术后的一个主要问题，在颈内动脉支架置入术后是罕见事件，但在颅外椎动脉和颅内动脉狭窄治疗后相对常见且可能使预后恶化。药物洗脱支架已证明其在控制ISR方面的疗效，并极大地改变了介入心脏病学的格局，为此其在脑血管系统中的评估目前正在开展。血管内介入领域正在迅速发展，用于脑血管系统的设备的开发无疑将扩大可治疗病变的范围。
