Dongzhimen Hospital, Beijing University of Chinese Medicine (BUCM), Beijing, China.
School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Medicine (Baltimore). 2024 Oct 11;103(41):e40055. doi: 10.1097/MD.0000000000040055.
Intracranial atherosclerotic stenosis (ICAS) represents a prevalent global cause of stroke, posing a notably higher risk of stroke recurrence than other stroke etiologies. Herein, we report a case of a 39-year-old male patient diagnosed with ICAS, treated through an integrated approach incorporating Chinese and Western medicine with significant efficacy and satisfied clinical safety.
This patient presented with 1 transient ischemic attack and prolonged headache, dizziness and poor sleep quality. In addition, the patient refused to undergo surgery due to the high cost and postoperative risks.
Diagnostic methods used to identify ICAS include conventional cerebral angiography, magnetic resonance angiography (MRA), CT angiography (CTA), transcranial Doppler ultrasound (TCD), and High-Resolution Magnetic resonance imaging. Considering the cost and risks associated with conventional angiography, noninvasive imaging has emerged as the method of choice for diagnosing ICAS. After a series of noninvasive examinations (CTA, TCD, and HR-MRI), the patient was diagnosed with ICAS.
The western medical regimen includes antiplatelet coagulation, blood pressure control, lipid regulation, plaque stabilization, and lifestyle modifications such as exercise, weight loss, and adherence to low-salt, low-fat diets. Complementing this, traditional Chinese medicine (TCM) treatment was guided by the principle of strengthening the spleen, resolving dampness, nourishing blood and harmonizing ying, resolving blood stasis and clearing collaterals. This involved the administration oral Chinese medicine such as modified Shenling Baizhu powder and modified Si Wu decoction.
The efficacy of the treatment was assessed by evaluating the degree of luminal stenosis and peak systolic blood flow velocity in the M1 segment of the left middle cerebral artery (MCA) before and after the intervention. Encouragingly, posttreatment results demonstrated the disappearance of the plaque in the left MCA-M1 segment, with no significant lumen stenosis observed. Moreover, a notable and smooth reduction in blood flow velocity was achieved in the left MCA, indicating positive outcomes from the integrated traditional Chinese and Western medicine approach.
This case report shows that a combination of traditional Chinese and Western medicine is safe and effective in the treatment of ICAS and is worthy of promotion in the clinic.
颅内动脉粥样硬化性狭窄（ICAS）是一种普遍存在的全球卒中病因，其卒中复发风险明显高于其他卒中病因。在此，我们报告了一例 39 岁男性患者，该患者经中西医学结合治疗取得了显著疗效和满意的临床安全性。
该患者表现为一过性脑缺血发作和持续性头痛、头晕及睡眠质量差。此外，由于手术费用高和术后风险大，患者拒绝手术。
ICAS 的诊断方法包括常规脑血管造影、磁共振血管造影（MRA）、CT 血管造影（CTA）、经颅多普勒超声（TCD）和高分辨率磁共振成像（HR-MRI）。考虑到常规血管造影的成本和风险，无创成像已成为诊断 ICAS 的首选方法。在一系列非侵入性检查（CTA、TCD 和 HR-MRI）后，患者被诊断为 ICAS。
西医治疗方案包括抗血小板聚集、控制血压、调节血脂、稳定斑块以及生活方式改变，如运动、减肥和低盐、低脂饮食。此外，还采用了中医治疗，以健脾、祛湿、养血、调和营卫、活血化瘀、通络为原则，给予口服中药，如参苓白术散和四物汤加减。
通过评估左大脑中动脉（MCA）M1 段管腔狭窄程度和收缩期血流速度峰值来评估治疗效果。令人鼓舞的是，治疗后左 MCA-M1 段斑块消失，管腔无明显狭窄。此外，左 MCA 血流速度明显平稳降低，表明中西医学结合治疗效果良好。
本病例报告表明，中西医学结合治疗 ICAS 安全有效，值得在临床上推广。
