Banerjee Chirantan, Chimowitz Marc I
From the Department of Neurology, Stroke Division, Medical University of South Carolina, Charleston.
Circ Res. 2017 Feb 3;120(3):502-513. doi: 10.1161/CIRCRESAHA.116.308441.
Our goal in this review is to discuss the pathophysiology, diagnosis, and treatment of stroke caused by atherosclerosis of the major intracranial arteries. References for the review were identified by searching PubMed for related studies published from 1955 to June 2016 using search terms intracranial stenosis and intracranial atherosclerosis. Reference sections of published randomized clinical trials and previously published reviews were searched for additional references. Intracranial atherosclerotic disease is a highly prevalent cause of stroke that is associated with a high risk of recurrent stroke. It is more prevalent among blacks, Hispanics, and Asians compared with whites. Diabetes mellitus, hypertension, metabolic syndrome, smoking, hyperlipidemia, and a sedentary lifestyle are the major modifiable risk factors associated with intracranial atherosclerotic disease. Randomized clinical trials comparing aggressive management (dual antiplatelet treatment for 90 days followed by aspirin monotherapy and intensive management of vascular risk factors) with intracranial stenting plus aggressive medical management have shown medical management alone to be safer and more effective for preventing stroke. As such, aggressive medical management has become the standard of care for symptomatic patients with intracranial atherosclerotic disease. Nevertheless, there are subgroups of patients who are still at high risk of stroke despite being treated with aggressive medical management. Future research should aim to establish clinical, serological, and imaging biomarkers to identify high-risk patients, and clinical trials evaluating novel therapies should be focused on these patients.
本综述的目的是探讨由主要颅内动脉粥样硬化引起的中风的病理生理学、诊断和治疗。通过在PubMed上搜索1955年至2016年6月发表的相关研究来确定本综述的参考文献，搜索词为颅内狭窄和颅内动脉粥样硬化。还检索了已发表的随机临床试验的参考文献部分以及先前发表的综述以获取更多参考文献。颅内动脉粥样硬化疾病是中风的一个高度常见病因，与中风复发的高风险相关。与白人相比，在黑人、西班牙裔和亚洲人中更为普遍。糖尿病、高血压、代谢综合征、吸烟、高脂血症和久坐不动的生活方式是与颅内动脉粥样硬化疾病相关的主要可改变风险因素。比较积极治疗（90天双重抗血小板治疗，随后阿司匹林单药治疗以及强化管理血管危险因素）与颅内支架置入术加积极药物治疗的随机临床试验表明，单纯药物治疗在预防中风方面更安全、更有效。因此，积极的药物治疗已成为有症状的颅内动脉粥样硬化疾病患者的标准治疗方法。然而，仍有一些患者亚组，尽管接受了积极的药物治疗，但仍处于中风的高风险中。未来的研究应旨在建立临床、血清学和影像学生物标志物以识别高风险患者，评估新疗法的临床试验应聚焦于这些患者。
