Leng Xinyi, Wong Ka Sing, Leung Thomas W
a Department of Medicine & Therapeutics , The Chinese University of Hong Kong , Hong Kong SAR , China.
Expert Rev Neurother. 2016 Jun;16(6):701-9. doi: 10.1080/14737175.2016.1179111. Epub 2016 May 6.
Intracranial atherosclerotic disease is the most common cause of cerebral vasculopathy and an important stroke etiology worldwide, with a higher prevalence in Asian, Hispanic and African ethnicities. Symptomatic intracranial atherosclerotic disease portends a recurrent stroke risk as high as 18% at one year. The key to secondary prevention is an understanding of the underlying stroke mechanism and aggressive control of conventional cardiovascular risks. Contemporary treatment includes antiplatelet therapy, optimal glycemic and blood pressure control, statin therapy and lifestyle modifications. For patients with high-grade (70-99%) symptomatic steno-occlusion, short-term dual antiplatelet therapy with aspirin and clopidogrel followed by life-long single antiplatelet therapy may reduce the recurrent risk. Current evidence does not advocate percutaneous transluminal angioplasty and stenting as an initial treatment. External counterpulsation, encephaloduroarteriosynangiosis and remote limb ischemic preconditioning are treatments under investigation. Future studies should aim at predicting patients prone to recurrence despite of medical therapies and testing the efficacy of emerging therapies.
颅内动脉粥样硬化性疾病是全球范围内脑血管病最常见的病因，也是重要的卒中病因，在亚洲、西班牙裔和非洲裔人群中患病率更高。有症状的颅内动脉粥样硬化性疾病预示着1年内复发性卒中风险高达18%。二级预防的关键在于了解潜在的卒中机制并积极控制传统心血管危险因素。当代治疗方法包括抗血小板治疗、优化血糖和血压控制、他汀类药物治疗以及生活方式改变。对于有症状的重度（70-99%）狭窄闭塞患者，短期使用阿司匹林和氯吡格雷双重抗血小板治疗，随后长期单一抗血小板治疗可能会降低复发风险。目前的证据不主张将经皮腔内血管成形术和支架置入术作为初始治疗方法。体外反搏、脑-硬脑膜-动脉血管融合术和远程肢体缺血预处理正在研究中。未来的研究应致力于预测尽管接受了药物治疗仍易复发的患者，并测试新出现治疗方法的疗效。
