Moore Justin M, Griessenauer Christoph J, Gupta Raghav, Adeeb Nimer, Patel Apar S, Ogilvy Christopher S, Thomas Ajith J
Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Clin Neurol Neurosurg. 2016 Sep;148:22-8. doi: 10.1016/j.clineuro.2016.06.007. Epub 2016 Jun 18.
The management of cerebrovascular disease has advanced considerably in 2015. Five randomized control trials have firmly established the role of endovascular thrombectomy for ischemic strokes due to large vessel occlusion. The randomized trial of intraarterial treatment for acute ischemic stroke (MR CLEAN) (Berkhemer et al. NEJM 2015;372:11-20) was the first of a series on the topic. There was a total of 5 randomized controlled trials published showing benefit in terms of functional outcomes at 90days for mechanical thrombectomy including the Endovascular Therapy for Ischemic stroke with perfusion-imaging selection (EXTEND IA) (Campbell et al. NEJM 2015;372:1009-18), the Randomized assessment of rapid endovascular treatment of ischemic stroke (ESCAPE) (Goyal et al. NEJM 2015;372:1019-30) trials, the stent-retriever thrombectomy after IV t-PA is t-PA alone in stroke (SWIFT-PRIME) (Saver et al. NEJM 2015;372:2285-95), and the thrombectomy within 8h after symptom onset in Ischemic stroke (REVASCAT) trial (Jovin et al. NEJM 2015; 372:2296-306). Six-year results from randomized controlled Barrow Ruptured Aneurysm Trial (BRAT) found no significant difference in functional outcomes in patients ruptured aneurysms treated surgically clippings versus endovascular treatment (Spetzler et al. JNS 2015;123:609-17. The 10-year results of the International Subarachnoid Aneurysm trial (ISAT) reported similar mortality rates and good functional outcomes between clipped and coiled patients (Molyneux et al. Lancet 2015;385:691-7). We also discuss the impact of genome wide sequencing studies in familial aneurysms, the largest publication on stent assisted coiling and flow diverter for aneurysms and noteworthy papers relevant to Moyamoya and cavernous malformations (Yang et al. Neurosurgery 2015;77:241-7).
2015年，脑血管疾病的治疗取得了显著进展。五项随机对照试验已明确证实血管内血栓切除术对因大血管闭塞导致的缺血性中风的作用。急性缺血性中风动脉内治疗的随机试验（MR CLEAN）（伯克默等人，《新英格兰医学杂志》2015年；372:11 - 20）是该主题系列试验中的首个试验。共有5项随机对照试验发表，显示机械取栓术在90天时的功能结局方面具有益处，包括缺血性中风灌注成像选择的血管内治疗（EXTEND IA）（坎贝尔等人，《新英格兰医学杂志》2015年；372:1009 - 18）、缺血性中风快速血管内治疗的随机评估（ESCAPE）（戈亚尔等人，《新英格兰医学杂志》2015年；372:1019 - 30）试验、静脉注射t - PA后支架取栓术与单纯t - PA治疗中风（SWIFT - PRIME）（萨弗等人，《新英格兰医学杂志》2015年；372:2285 - 95），以及缺血性中风症状发作后8小时内的取栓术（REVASCAT）试验（乔文等人，《新英格兰医学杂志》2015年；372:2296 - 306）。随机对照的巴罗破裂动脉瘤试验（BRAT）的六年结果发现，接受手术夹闭与血管内治疗的破裂动脉瘤患者在功能结局方面无显著差异（斯佩茨勒等人，《神经外科杂志》2015年；123:609 - 17）。国际蛛网膜下腔动脉瘤试验（ISAT）的十年结果报告称，夹闭和栓塞患者的死亡率相似且功能结局良好（莫利纽克斯等人，《柳叶刀》2015年；385:691 - 7）。我们还讨论了全基因组测序研究对家族性动脉瘤的影响、关于动脉瘤支架辅助栓塞和血流导向装置的最大规模出版物，以及与烟雾病和海绵状畸形相关的重要论文（杨等人，《神经外科》2015年；77:241 - 7）。
