切换至 "中华医学电子期刊资源库"

中华脑血管病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 181 -184. doi: 10.11817/j.issn.1673-9248.2021.03.009

综述

慢性颅内大血管闭塞再通研究现状
张志成1, 唐颖馨2, 潘超2, 张萍2, 骆翔2, 徐沙丽3, 唐洲平2,()   
  1. 1. 430030 武汉,华中科技大学同济医学院附属同济医院神经内科;430077 武汉,华中科技大学同济医学院附属梨园医院神经内科
    2. 430030 武汉,华中科技大学同济医学院附属同济医院神经内科
    3. 430077 武汉,华中科技大学同济医学院附属梨园医院神经内科
  • 收稿日期:2020-04-22 出版日期:2021-06-01
  • 通信作者: 唐洲平
  • 基金资助:
    国家自然科学基金(81873750,82071330)

Research progress of endovascular treatment for chronic intracranial large artery occlusion

Zhicheng Zhang1, Yingxin Tang2, Chao Pan2, Ping Zhang2, Xiang Luo2, Shali Xu3, Zhouping Tang2,()   

  1. 1. Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030 China; Department of Neurology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
    2. Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030 China
    3. Department of Neurology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
  • Received:2020-04-22 Published:2021-06-01
  • Corresponding author: Zhouping Tang
引用本文:

张志成, 唐颖馨, 潘超, 张萍, 骆翔, 徐沙丽, 唐洲平. 慢性颅内大血管闭塞再通研究现状[J]. 中华脑血管病杂志(电子版), 2021, 15(03): 181-184.

Zhicheng Zhang, Yingxin Tang, Chao Pan, Ping Zhang, Xiang Luo, Shali Xu, Zhouping Tang. Research progress of endovascular treatment for chronic intracranial large artery occlusion[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(03): 181-184.

血管内治疗已经成为急性颅内大血管闭塞时间窗内的有效治疗手段。但对颅内大动脉非急性和慢性闭塞的介入治疗,国内外尚缺乏统一的指南。目前关于非急性和慢性血管闭塞再通的研究逐渐增多,但仍有许多问题需要解决,且尚缺乏大型随机对照试验。本文主要对慢性颅内大血管闭塞的术前评估、治疗进展、治疗并发症等问题进行了综述,总结了部分学者的诊疗经验。为今后广泛开展该项技术提供宝贵的经验积累,并为后续研究作一铺垫。

Endovascular treatment has been proven to be an effective treatment in ischemic stroke due to acute large vessel occlusion within the time window. However, there is a lack of guideline consensus on interventional treatment for non-acute and chronic intracranial large artery occlusion. At present, the researches on recanalization of non-acute and chronic vascular occlusion are gradually increasing, but there are still many issues to be solved, and there is still a lack of large randomized controlled trials. This paper mainly reviews the preoperative assessment, treatment advance, and complications of interventional therapy for chronic intracranial large artery occlusion, and summarizes the diagnosis and treatment experience from some reseachers . It will provide valuable experience for applying this technology widely in the future and pave the way for the advancement.

1
Gorelick PB, Wong KS, Bae HJ, et al. Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier [J]. Stroke, 2008, 39(8): 2396-2399.
2
Wong LKS. Global burden of intracranial atherosclerosis [J]. Int J Stroke, 2006, 1(3): 158-159.
3
Marshall RS, Festa JR, Cheung YK, et al. Cerebral hemodynamics and cognitive impairment: baseline data from the RECON trial [J]. Neurology, 2012, 78(4): 250-255.
4
Chimowitz MI, Derdeyn CP. Endovascular therapy for atherosclerotic intracranial arterial stenosis: back to the drawing board [J]. JAMA, 2015, 313(12): 1219-1220.
5
Weimar C, Goertler M, Harms L, et al. Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia [J]. Arch Neurol, 2006, 63(9): 1287-1291.
6
Rotzinger DC, Mosimann PJ, Meuli RA, et al. Site and rate of occlusive disease in cervicocerebral arteries: a CT angiography study of 2209 patients with acute ischemic stroke [J]. AJNR Am J Neuroradiol, 2017, 38(5): 868-874.
7
Wang Y, Zhao X, Liu L, et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese intracranial atherosclerosis (CICAS) study [J]. Stroke, 2014, 45(3): 663-669.
8
Kuroda S, Houkin K, Kamiyama H, et al. Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it? [J]. Stroke, 2001, 32(9): 2110-2116.
9
Khatri J, Abdallah M, Ellis S. Management of coronary chronic total occlusion [J]. Cleve Clin J Med, 2017, 84(12 Suppl 3): 27-38.
10
Alexander MJ, Zauner A, Gupta R, et al. The WOVEN trial: wingspan one-year vascular events and neurologic outcomes [J]. J Neurointerv Surg, 2021, 13(4): 307-310.
11
McBride DW, Wu G, Nowrangi D, et al. Delayed recanalization promotes functional recovery in rats following permanent middle cerebral artery occlusion [J]. Transl Stroke Res, 2018, 9(2): 185-198.
12
中国医师协会介入医师分会神经介入专业委员会, 中华医学会放射学分会介入放射学组, 中国卒中学会复合介入神经外科分会. 慢性颈内动脉闭塞再通治疗中国专家共识 [J/CD]. 中华介入放射学电子杂志, 2019, 7(1): 1-6.
13
Hasan D, Zanaty M, Starke RM, et al. Feasibility, safety, and changes in systolic blood pressure associated with endovascular revascularization of symptomatic and chronically occluded cervical internal carotid artery using a newly suggested radiographic classification of chronically occluded cervical internal carotid artery: pilot study [J]. J Neurosurg, 2018, 1: 1-10.
14
Zheng M, Song Y, Zhang J, et al. Endovascular recanalization of non-acute symptomatic middle cerebral artery total occlusion and its short-term outcomes [J]. Front Neurol, 2019, 10: 484.
15
Iwata T, Mori T, Tanno Y, et al. Subacute percutaneous cerebral balloon angioplasty for middle cerebral artery occlusion in patients with internal border zone infarcts [J]. J Neurol Surg A Cent Eur Neurosurg, 2017, 78(1): 25-32.
16
Gao F, Guo X, Han J, et al. Endovascular recanalization for symptomatic non-acute middle cerebral artery occlusion: proposal of a new angiographic classification [J]. J Neurointerv Surg, 2020: neurintsurg-2020-016692. Online ahead of print.
17
Hawkes MA, Blaginykh E, Ruff MW, et al. Long-term mortality, disability and stroke recurrence in patients with basilar artery occlusion [J]. Eur J Neurol, 2020, 27(3): 579-585.
18
Lindsberg PJ, Soinne L, Roine RO, et al. Options for recanalization therapy in basilar artery occlusion [J]. Stroke, 2005, 36(2): 203-204.
19
Dashti SR, Park MS, Stiefel MF, et al. Endovascular recanalization of the subacute to chronically occluded basilar artery: initial experience and technical considerations [J]. Neurosurgery, 2010, 66(4): 825-831; discussion 831-822.
20
周志龙, 朱良付, 李天晓, 等. 症状性椎动脉颅内段非急性闭塞血管内开通治疗研究 [J]. 中国脑血管病杂志, 2020, 17(7): 391-397.
21
Gao F, Sun X, Zhang H, et al. Endovascular recanalization for nonacute intracranial vertebral artery occlusion according to a new classification [J]. Stroke, 2020, 51(11): 3340-3343.
22
Lau AY, Wong EH, Wong A, et al. Significance of good collateral compensation in symptomatic intracranial atherosclerosis [J]. Cerebrovasc Dis, 2012, 33(6): 517-524.
23
Sakes A, Regar E, Dankelman J, et al. Treating total occlusions: applying force for recanalization [J]. IEEE Rev Biomed Eng, 2016, 9: 192-207.
24
Stone GW, Reifart NJ, Moussa I, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part Ⅱ [J]. Circulation, 2005, 112(16): 2530-2537.
25
中华医学会神经病学分会神经血管介入协作组, 中国医师协会神经内科医师分会神经介入专业委员会, 中国研究型医院学会介入神经病学专业委员会. 中国颅内外大动脉非急性闭塞血管内介入治疗专家共识 [J]. 中华内科杂志, 2020, 59(12): 932-941.
26
Lee DH, Sung JH, Kim SU, et al. Effective use of balloon guide catheters in reducing incidence of mechanical thrombectomy related distal embolization [J]. Acta Neurochir(wien), 2017, 159(9): 1671-1677.
27
Broderick JP. The challenges of intracranial revascularization for stroke prevention [J]. N Engl J Med, 2011, 365(11): 1054-1055.
28
He Y, Bai W, Li T, et al. Perioperative complications of recanalization and stenting for symptomatic nonacute vertebrobasilar artery occlusion [J]. Ann Vasc Surg, 2014, 28(2): 386-393.
29
Sundt TM, Sharbrough FW, Piepgras DG, et al. Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia [J]. Mayo Clin Proc, 1981, 56(9): 533-543.
30
Abou-Chebl A, Yadav JS, Reginelli JP, et al. Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting: risk factors, prevention, and treatment [J]. J Am Coll Cardiol, 2004, 43(9): 1596-1601.
[1] 王友芳, 李兴超, 朱晓松, 刘清敏, 张建国, 杨淑红, 相然, 张蒙蒙, 车峰远. 预后营养指数对急性颅内动脉粥样硬化性大血管闭塞患者预后评估价值分析[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 193-197.
[2] 王晓东, 秦兆为, 罗志松, 谢树浩, 李钦喜, 朱志辉. 抽吸取栓和支架取栓治疗急性缺血性脑卒中的疗效对比分析[J]. 中华神经创伤外科电子杂志, 2022, 08(02): 81-86.
[3] 徐建军, 王宏磊, 乔萌, 冯颖利, 徐宁. 血管内介入治疗合并单侧烟雾病的前交通动脉瘤[J]. 中华神经创伤外科电子杂志, 2022, 08(01): 39-43.
[4] 张萌, 苏道庆, 张利勇, 郝继恒, 崔庆轲, 王继跃. 经肱动脉入路串联双支架取栓一例报道[J]. 中华神经创伤外科电子杂志, 2020, 06(06): 383-384.
[5] 谭海斌, 张天, 黄光富, 李志立, 王振宇, 程美雄, 刘泠, 刘灵童, 胡晓, 胡俊亭. 前循环血泡样动脉瘤显微手术和血管内介入治疗的对比分析[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(02): 75-81.
[6] 徐少锋, 王致强, 胡红杰. 疤痕妊娠明胶海绵介入栓塞后子宫动脉再通的影响因素[J]. 中华介入放射学电子杂志, 2023, 11(01): 30-34.
[7] 林枫, 张鸿运, 贺迎坤, 李天晓. 围术期NLR变化可预测急性前循环大血管闭塞性卒中取栓患者的临床预后[J]. 中华介入放射学电子杂志, 2022, 10(04): 396-403.
[8] 刘超, 郝继恒, 张萌, 王子栋, 蒋群龙, 刘卫东, 代高磊, 王继跃, 张利勇. 颈动脉穿刺联合"Y"型双支架技术治疗急性大脑中动脉闭塞困难取栓1例[J]. 中华介入放射学电子杂志, 2022, 10(02): 228-232.
[9] 王俊杰, 尹晓亮, 刘二腾, 陆军, 祁鹏, 胡深, 杨希孟, 陈鲲鹏, 张东, 王大明. 机器学习对预测颈内动脉非急性闭塞患者血管内再通术成功的潜在价值[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 464-470.
[10] 孙洪扬, 刘基, 龚字翔, 王广英, 宁召腾, 赵璇, 朱其义, 王贤军. 急性前循环大血管闭塞性轻型卒中血管内治疗的临床预后及手术时机选择[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 445-451.
[11] 许志威, 刘辉华, 覃伟钊, 封桂宇, 李贤, 覃翠, 林洁洁, 梁国辉. 芪蛭丹通络胶囊治疗非急性期缺血性中风气虚血瘀证的临床疗效[J]. 中华脑血管病杂志(电子版), 2023, 17(03): 232-236.
[12] 张文胜, 幸伟芳, 谢颖, 何锦照. 急性前循环大血管闭塞血管内治疗头颅CT高密度影的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 159-162.
[13] 曹杨, 张凯, 张士永. 低NIHSS评分伴大血管闭塞性急性缺血性卒中机械取栓治疗效果分析[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 107-111.
[14] 郭晖, 徐文君, 宋仁兴, 李伟, 庞春晓, 王增武. 支架取栓术后亚低温对急性大血管闭塞性缺血性脑卒中患者血清S100β蛋白水平的影响[J]. 中华脑血管病杂志(电子版), 2020, 14(05): 275-280.
[15] 谢凯凯, 曹文锋, 项正兵, 刘世民, 饶伟, 吴凌峰. 重组组织型纤溶酶原激活剂静脉溶栓与桥接治疗对前循环大血管闭塞的临床疗效比较[J]. 中华脑血管病杂志(电子版), 2020, 14(02): 90-95.
阅读次数
全文


摘要