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Current Advances in Endovascular Treatment of Intracranial Atherosclerotic Disease and Future Prospective

机译:颅内动脉粥样硬化性疾病血管内治疗进展及展望

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Objectives/Background: Medical therapy is the first line of treatment for intracranial atherosclerotic disease (ICAD). Percutaneous transluminal angioplasty and stenting (PTAS) are mainly considered for those patients with severe stenosis and recurrent events despite aggressive medical therapy. In this review, we discuss the application of PTAS as a treatment option for ICAD and its future prospect. Materials and Methods: We did the literature review of the key articles and guidelines to elaborate on the role of PTAS in the management of ICAD based on the current data and expert opinion. We searched PubMed, Google Scholar, and Scopus up to August 2020, and included articles published only in the English language. Results: Since the publication of the results from SAMMPRIS and VISSIT trials, stenting is no longer recommended for secondary stroke prevention in patients with symptomatic ICAD. However, recent clinical studies on intracranial stenting for a subgroup of ICAD patients have shown promising results, likely due to better patient selection and continued advancement of endovascular techniques. Conclusion: There exists a lack of consensus regarding the best endovascular treatment approach (e.g., angioplasty alone or balloon mounted stent vs. self-expanding stent with or without prior angioplasty) or management of in-stent restenosis. Another area of clinical controversy relates to the ideal use and duration of antiplatelet therapy.
机译:目的/背景:药物治疗是颅内动脉粥样硬化疾病 (ICAD) 的一线治疗。经皮腔内血管成形术和支架置入术 (PTAS) 主要用于那些尽管积极药物治疗但仍存在严重狭窄和复发事件的患者。本文将探讨PTAS作为ICAD治疗选择的应用及其未来前景。材料与方法:我们根据现有数据和专家意见,对关键文章和指南进行了文献综述,以详细阐述PTAS在ICAD管理中的作用。我们检索了截至 2020 年 8 月的 PubMed、Google Scholar 和 Scopus,并纳入了仅以英语发表的文章。结果:自SAMMPRIS和VISSIT试验结果公布以来,不再推荐支架置入术用于有症状的ICAD患者的二级卒中预防。然而,最近针对 ICAD 患者亚组的颅内支架置入术的临床研究显示出有希望的结果,这可能是由于更好的患者选择和血管内技术的持续进步。结论:关于最佳血管内治疗方法(例如,单独血管成形术或球囊安装支架与自扩张支架,有或没有既往血管成形术)或支架内再狭窄的治疗,目前尚缺乏共识。另一个临床争议领域与抗血小板治疗的理想用途和持续时间有关。

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