Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Stroke Vasc Neurol. 2019 Oct 16;5(1):59-64. doi: 10.1136/svn-2019-000279. eCollection 2020.
This review highlights the recent evolution of the imaging, medical management, surgical options and endovascular therapies for symptomatic intracranial atherosclerotic disease (ICAD). Recent imaging developments including optical coherence tomography and other modalities to assess the intracranial arteries for symptomatic ICAD are reviewed, not only to diagnose ICAD but to determine if ICAD plaques have any high-risk features for treatment. Potential future developments in the treatment of ICAD are discussed, including the development of trackable drug-coated balloons for the cerebral circulation to treat primary or restenotic arteries, new iterations of self-expanding intracranial stents with easier delivery systems, and the re-examination of indirect surgical bypass techniques for revascularisation. In addition to these important technological developments, however, is the evolving evidence regarding the best treatment window for these techniques and additional factors in medical management which can improve patient outcomes in this devastating pathology.
这篇综述强调了症状性颅内动脉粥样硬化性疾病（ICAD）的影像学、医学管理、手术选择和血管内治疗的最新进展。回顾了包括光相干断层扫描在内的最近的影像学发展，以及其他评估症状性 ICAD 颅内动脉的方法，不仅是为了诊断 ICAD，还为了确定 ICAD 斑块是否具有任何需要治疗的高危特征。讨论了 ICAD 治疗的潜在未来发展，包括用于治疗原发性或再狭窄动脉的可追踪药物涂层球囊在脑循环中的发展、具有更简单输送系统的自膨式颅内支架的新迭代，以及重新审视用于血运重建的间接手术旁路技术。然而，除了这些重要的技术发展之外，还有关于这些技术的最佳治疗窗口以及医学管理中可以改善该破坏性病理患者预后的其他因素的不断发展的证据。
