Luo Jichang, Wang Tao, Gao Peng, Krings Timo, Jiao Liqun
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
UHN Joint Department of Medical Imaging Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
Front Neurol. 2018 Aug 21;9:666. doi: 10.3389/fneur.2018.00666. eCollection 2018.
Intracranial atherosclerotic stenosis (ICAS) is a common cause of transient ischemic attack (TIA) and ischemic stroke. Endovascular treatment, including balloon angioplasty alone, balloon-mounted stents, and self-expandable stent placement with or without prior angioplasty, is an alternative to medical treatment for the prevention of recurrent TIA or ischemic stroke in patients with ICAS. Although the SAMMPRIS and VISSIT trials supported medical management alone against endovascular treatments, both randomized controlled trials (RCT) were criticized due to flaws relating to patient-, intervention-, and operator-related factors. In this review, we discuss the current debate regarding these aspects and suggest approaches to solve current controversies in the future. In our opinion, endovascular treatment in carefully selected patients, individualized choice of endovascular treatment subtypes, and an experienced multidisciplinary team managing the patient in the pre-, peri- and post-procedural period have the potential to provide safe and efficious treatment of patients with symptomatic ICAS.
颅内动脉粥样硬化性狭窄（ICAS）是短暂性脑缺血发作（TIA）和缺血性卒中的常见病因。血管内治疗，包括单纯球囊血管成形术、球囊扩张支架置入术以及有或无预扩张的自膨式支架置入术，是预防ICAS患者复发性TIA或缺血性卒中的一种替代药物治疗的方法。尽管SAMMPRIS和VISSIT试验支持单纯药物治疗而非血管内治疗，但这两项随机对照试验（RCT）均因与患者、干预措施和操作者相关的因素存在缺陷而受到批评。在本综述中，我们讨论了当前关于这些方面的争论，并提出了未来解决当前争议的方法。我们认为，在精心挑选的患者中进行血管内治疗、个体化选择血管内治疗亚型以及由经验丰富的多学科团队在术前、术中和术后对患者进行管理，有可能为有症状的ICAS患者提供安全有效的治疗。
