Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Semin Neurol. 2023 Jun;43(3):337-344. doi: 10.1055/s-0043-1771207. Epub 2023 Aug 7.
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of acute ischemic stroke worldwide. Patients with acute large vessel occlusion due to underlying ICAD (ICAD-LVO) often do not achieve successful recanalization when undergoing mechanical thrombectomy (MT) alone, requiring rescue treatment, including intra-arterial thrombolysis, balloon angioplasty, and stenting. Therefore, early detection of ICAD-LVO before the procedure is important to enable physicians to select the optimal treatment strategy for ICAD-LVO to improve clinical outcomes. Early diagnosis of ICAD-LVO is challenging in the absence of consensus diagnostic criteria on noninvasive imaging and early digital subtraction angiography. In this review, we summarize the clinical and diagnostic criteria, prediction of ICAD-LVO prior to the procedure, and EVT strategy of ICAD-LVO and provide recommendations according to the current literature.
颅内动脉粥样硬化性疾病（ICAD）是全球范围内急性缺血性脑卒中的最常见病因之一。由于基础 ICAD 导致的急性大血管闭塞（ICAD-LVO）患者，单独进行机械取栓（MT）通常无法实现成功再通，需要进行挽救治疗，包括动脉内溶栓、球囊血管成形术和支架置入术。因此，在进行 MT 前早期发现 ICAD-LVO 对于医生选择最佳的 ICAD-LVO 治疗策略以改善临床结局非常重要。在缺乏非侵入性影像学和早期数字减影血管造影（DSA）的共识诊断标准的情况下，ICAD-LVO 的早期诊断具有挑战性。在本文中，我们总结了 ICAD-LVO 的临床和诊断标准、术前预测以及 EVT 策略，并根据现有文献提出了建议。
