Zhang Jianmin
Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2019 May 25;48(3):233-240. doi: 10.3785/j.issn.1008-9292.2019.06.01.
Restoration of cerebral blood flow is particularly important for the treatment of ischemic cerebrovascular disease. It is notable that surgical approaches play a unique role in treating this devastating disease. Among them, mechanical thrombectomy facilitates rapid and effective recanalization of occluded intracranial large vessels causing ischemic stroke, which contributes to improvement of cerebral perfusion in the ischemic penumbra; decompressive craniectomy is an important therapeutic option for acute massive cerebral infarction, and the timing of surgery determines the final clinical outcomes; for carotid endarterectomy in carotid-artery stenosis, individualized surgical plan is important for the safety and effectiveness of the operation; in the surgical revascularization of Moyamoya disease, precise evaluation of clinical and radiological characteristics, optimal surgical strategies and accuracy of intraoperative judgment will yield maximal therapeutic effects; and hybrid surgery is feasible for the therapy of complex ischemic cerebrovascular diseases, such as extracranial/intracranial arteries tandem stenosis and symptomatic chronic total occlusion of carotid artery. This paper reviews recent technical and clinical advances in the surgical treatment of ischemic cerebrovascular disease.
恢复脑血流对缺血性脑血管疾病的治疗尤为重要。值得注意的是，手术方法在治疗这种毁灭性疾病中发挥着独特作用。其中，机械取栓术有助于快速有效地再通导致缺血性卒中的颅内大血管闭塞，这有助于改善缺血半暗带的脑灌注；减压性颅骨切除术是急性大面积脑梗死的重要治疗选择，手术时机决定最终临床结局；对于颈动脉狭窄的颈动脉内膜切除术，个体化手术方案对手术的安全性和有效性很重要；在烟雾病的外科血管重建术中，精确评估临床和影像学特征、优化手术策略以及术中判断的准确性将产生最大治疗效果；而杂交手术对于治疗复杂缺血性脑血管疾病是可行的，如颅外/颅内动脉串联狭窄和有症状的颈动脉慢性完全闭塞。本文综述了缺血性脑血管疾病外科治疗的最新技术和临床进展。
