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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (04) : 370 -377. doi: 10.3877/cma.j.issn.2095-5782.2020.04.015

所属专题： 文献；

综述

脑动脉闭塞腔内介入治疗的研究进展和应用
徐放1, 王峰1,†(), 刘永晟1   
  1. 1. 116000　辽宁大连，大连医科大学附属第一医院介入治疗科
  • 收稿日期:2020-05-20 出版日期:2020-11-25
  • 通信作者: 王峰

Research progress and application of endovascular interventional therapy for cerebral artery occlusion

Fang Xu1, Feng Wang1,†(), Yongsheng Liu1   

  1. 1. Department of Interventional Therapy, the First Affiliated Hospital of Dalian Medical University, Liaoning Dalian 116000, China
  • Received:2020-05-20 Published:2020-11-25
  • Corresponding author: Feng Wang
  • About author:
    Corresponding author: Wang Feng, Email:
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徐放, 王峰, 刘永晟. 脑动脉闭塞腔内介入治疗的研究进展和应用[J]. 中华介入放射学电子杂志, 2020, 08(04): 370-377.

Fang Xu, Feng Wang, Yongsheng Liu. Research progress and application of endovascular interventional therapy for cerebral artery occlusion[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(04): 370-377.

脑卒中是导致全球老年人死亡的第二大疾病，同时也是导致我国老年人死亡的首要病因。脑卒中因为其高发病率、高致残率和高死亡率，已经成为家庭和社会的沉重负担。按脑卒中发病机制分类，缺血性脑卒中约占80%以上，是导致脑卒中的最常见病因。既往对于脑血管闭塞的治疗主要以药物治疗和外科手术治疗为主，但效果有限。近年来，随着介入医生经验和治疗技术的不断积累、介入器材和影像学技术的飞速发展，介入再通治疗逐渐成为治疗慢性脑血管闭塞的重要手段之一，但对于脑动脉闭塞的介入治疗的临床疗效，目前仍然存在诸多争议。文章对脑动脉闭塞的成因、影像学诊断、治疗现状、介入治疗并发症及术后再狭窄等问题进行了研究和综述。

关键词: 脑动脉闭塞, 介入开通治疗, 再狭窄

Stroke is the second leading cause of death for the elderly in the world, and it is also the primary cause of death for the elderly in China. Stroke has become a heavy burden for families and society because of its high morbidity, disability and mortality. Ischemic stroke accounts for about 80% of stroke, which is the most common cause of stroke. In the past, the treatment of cerebrovascular occlusion was mainly drug treatment and surgical treatment, but the efficacy was limited. In recent years, with the continuous accumulation of interventional doctors' experience and treatment technology, and the rapid development of interventional equipment and imaging technology, interventional recanalization therapy has gradually become one of the important means to treat chronic cerebrovascular occlusion, but there are still many controversies about the clinical efficacy of interventional therapy for cerebral artery occlusion. This article reviews the causes, imaging diagnosis, treatment status, complications of interventional therapy and postoperative restenosis of cerebral artery occlusion.

Key words: Cerebral artery occlusion, Interventional recanalization therapy, Restenosis
[1]
董强，黄家星，黄一宁, 等. 症状性动脉粥样硬化性颅内动脉狭窄中国专家共识[J]. 中国神经精神疾病杂志, 2012(3): 129-145.
[2]
Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality:estimates from monitoring, surveillance, and modelling[J]. Lancet Neurol, 2009, 8(4): 345-354.
[3]
Liu L, Wang D, Wong KS, et a1. Stroke and stroke care in China:huge burden,significant workload, and a national priority[J].Stroke, 2011, 42(12): 3651-3654.
[4]
Go AS, Mozaffarian D, Roger VL, et a1. Heart disease and stroke statistics-2013 update:a report from the American Heart Association[J]. Circulation, 2013, 127(1): e6-e245.
[5]
Flaherty ML, Flemming KD, McClelland R, et al. Population-based study of symptomatic internal carotid artery occlusion:incidence and long-term follow up[J]. Stroke, 2004, 35(8): e349-e352.
[6]
Powers WJ. Atherosclerotic carotid artery occlusion[J]. CurrTreat Options Cardiovasc, 2003, 5: 501-509.
[7]
Grubb RL, Derdeyn CP, Fritsch SM, et al. Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion[J]. The Journal of the American Medical Association, 1998, 280(12): 1055-1060.
[8]
中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性期缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4): 246-257.
[9]
黄清海，刘建民. 慢性颈动脉闭塞血管内再通治疗评估与技术[J]. 中华脑血管病杂志, 2012, 6(6): 343-345.
[10]
Wouter JS, Christine ACW, Patrik M, et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study(BASICS): a prospective registry study[J]. Lancet Neurology, 2009, 8(8): 724-730.
[11]
Caplan LR, Wityk RJ, Glass TA, et a1. New England Medical Center posterior circulation registry[J]. Annals of Neurology, 2004, 56(3): 389-398.
[12]
Brandt T. Diagnosis and thrombolytic therapy of acute basilar artery occlusion: a review[J]. Clin Exp Hypertens, 2002, 24(7-8): 611-622.
[13]
Ferbert A, Bruckmann H, Drummen R. Clinical features of proven basilar artery occlusion[J]. Stroke, 1990, 21(8): 1135-1142.
[14]
Lee VH, Brown RD Jr, Mandrekar JN, Mokri B.Incidence and outcome of cervical artery dissection:a population-based study[J].Neurology, 2006, 67: 1809-1815.
[15]
Bigi S, Fischer U, Wehrli E, et al. Differences in risk-factors, aetiology, and outcome between children and young adults with acute ischaemic stroke[J]. Annals of Neurology, 2011, 70: 245-254.
[16]
Baird TA, Muir KW, Bone I. Basilar artery occlusion[J]. Neurocrit Care, 2004, 1(3): 319-329.
[17]
Mattle HP, Arnold M, Lindsberg PJ, et a1. Basilar artery occlusion[J]. Lancet Neurol, 2011, 10(11): 1002-1014.
[18]
Schoen JC, Boysen MM, Warren CR, et a1. Vertebrobasilar artery occlusion[J]. West J Emerg Med, 2011, 12(2): 233-239.
[19]
Volker W, Dittrich R, Grewe S, et al. The outer arterial wall layers are primarily affected in spontaneous cervical artery dissection[J].Neurology, 2011, 76(17): 1463-1471.
[20]
胡淼，余金，苏康, 等. 烟雾病的研究进展[J]. 中国实用神经疾病杂志, 2019, 22(15): 1736-1740.
[21]
Horn P, Bueltmann E, Buch CV, et al. Arterio-embolic ischemic stroke in children with moyamoya disease[J]. Child's Nervous System, 2005, 21(2): 104-107.
[22]
Fung LW, Thompson D, Ganesan V. Revascularisation surgery for paediatric moyamoya:a review of the literature[J]. Child's Nervous System, 2005, 21(5): 358-364.
[23]
Kraemer M, Berlit P, Diesner F, et al. What is the expert option on antiplatelet therapy in moyamoya disease? Results of a worldwide survey[J]. European Journal of Neurology, 2012, 19(1): 163-167.
[24]
Voetsch B, Dewitt LD, Pessin MS, et a1. Basilar artery occlusive disease in the New England Medical Center Posterior Circulation Registry[J]. Arch Neurol, 2004, 61(4): 496-504.
[25]
von Campe G, Regli F, Bogousslavsky J. Heralding manifestations of basilar artery occlusion with lethal or severe stroke[J]. Journal of Neurology and Psychiatry, 2003, 74(12): 1621-1626.
[26]
Marshall RS, Festa JR, Cheung YK, et al. Cerebral hemodynamics and cognitive impairment: baseline data from the RECON trial[J].Neurology, 2012, 78: 250-255.
[27]
Brandt T, Knauth M, Wildermuth S, et al. CT angiography and Doppler sonography for emergency assessment in acute basilar artery ischemia[J]. Stroke, 1999, 30(3): 606-612.
[28]
Byrnes KR, Ross CB. The current role of carotid duplex ultrasonography in the management of carotid atherosclerosis: foundations and advances[J]. International Journal of Vascular Medicine, 2012 :187872.
[29]
Leiva-Salinas C, Provenzale JM, Wintermark M.Responses to the 10 most frequently asked questions about perfusion CT[J]. AJR Am J Roentgenol, 2011, 196(1): 53-60.
[30]
Hui FK, Zhu X, Jones SE, et al. Early experience in high resolution MRI for large vessel occlusions[J]. Journal of NeuroInterventional Surgery, 2015, 7(7): 509-516.
[31]
Willinsky RA, Taylor SM, TerBrugge K, et al. Neurologic complications of cerebral angiography: prospective analysis of 2 899 procedures and review of the literature[J]. Radiology, 2003, 227(2): 522-528.
[32]
European Stroke Organisation (ESO) Executive Committee, et al. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008[J]. Journal of Stroke & Cerebrovascular Diseases, 2008, 25(5): 457-507.
[33]
刘武，邓宇平，罗伟, 等. 动脉内溶栓治疗急性脑梗死临床分析[J]. 中国现代药物应用, 2009, 3(14): 32-33.
[34]
Broderick JP, Palesch YY, Demchuk AM, et a1. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke[J]. The New England Journal of Medicine, 2013, 368(13): 1265.
[35]
中华预防医学会卒中预防与控制专业委员会. 急性缺血性脑卒中血管内治疗中国专家共识[J]. 中国脑血管病杂志, 2014, 11(10): 556-560.
[36]
Sacks D, Black CM, Cognard C, et al. Multisociety consensus quality improvement guidelines for intraarterial catheter-directed treatment of acute ischemic stroke, from the American Society of Neuroradiology, Canadian Interventional Radiology Association, Cardiovascular and Interventional Radiological Society of Europe, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, European Society of Minimally Invasive Neurological Therapy, and Society of Vascular and Interventional Neurology[J]. Journal of Vascular and Interventional Radiology, 2013, 24(2): 151-163.
[37]
陈荣华，彭亚，宣井岗, 等. 缺血性卒中急性期Solitaire AB支架机械取栓术的效果[J]. 中国脑血管病杂, 2013, 10(12): 620-624.
[38]
Ferrell AS, Britz GW. Developments on the horizon in the treatment of neurovascular problems[J]. Surgical Neurology International, 2013, 4(Suppl 1): S31-S37.
[39]
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J]. The New England Journal of Medicine, 2018, 378(1): 11-21.
[40]
Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging[J]. The New England Journal of Medicine, 2018, 378(8): 708-718.
[41]
Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke[J]. The New England Journal of Medicine, 2015, 372(24): 2285-2295.
[42]
Guedin P, Larcher A, Decroix JP, et al. Prior IV thrombolysis facilitates mechanical thrombectomy in acute ischemic stroke[J]. Journal of Stroke and Cerebrovascular Diseases, 2015, 24(5): 952-957.
[43]
Mistry EA, Mistry AM, Fusco MR. Response by Mistry et al to letter regarding article, "Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis"[J]. Stroke, 2017, 48(11): e334.
[44]
Behme D, Kabbasch C, Kowoll A, et al.Intravenous thrombolysis facilitates successful recanalization with stent-retriever mechanical thrombectomy in middle cerebral artery occlusions[J]. Journal of Stroke and Cerebrovascular Diseases, 2016, 25(4): 954-959.
[45]
Angermaier A, Michel P, Khaw AV, et al. Intravenous thrombolysis and passes of thrombectomy as predictors for endovascular revascularization in ischemic stroke[J]. Journal of Stroke and Cerebrovascular Diseases, 2016, 25(10): 2488-2495.
[46]
Pfefferkorn T, Holtmannspotter M, Schmidt C, et al. Drip, ship, and retrieve: cooperative recanalization therapy in acute basilar artery occlusion[J]. Stroke, 2010, 41(4): 722-726.
[47]
Lu PH, Park JW, Park S,et al.Intracranial stenting of subacute symptomatic atherosclerotic occlusion versus stenosis[J]. Stroke, 2011, 42: 3470-3476.
[48]
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.
[49]
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.
[50]
Yata K, Nishimura Y, Unekawa M, et al. In vivo imaging of the mouse neurovascular unit under chronic cerebral hypoperfusion[J]. Stroke, 2014, 45(12): 3698-3703.
[51]
Nishino A, Tajima Y, Takuwa H, et al. Long-term effects of cerebral hypoperfusion on neural density and function using misery perfusion animal model[J]. Scientific Reports, 2016, 6: 25072.
[52]
Powers WJ, Clarke WR, Grubb RL Jr, et al. Extracranial intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial[J]. The Journal of the American Medical Association, 2011, 306(18): 1983-1992.
[53]
Grubb RL Jr, Powers WJ, Clarke WR, et al.Surgical results of the Carotid Occlusion Surgery Study[J]. Journal of Neurosurgery, 2013, 118(1): 25-33.
[54]
Hafner CD, Tew JM. Surgical management of the totally occluded internal carotid artery:a ten-year study[J]. Surgery, 1981, 89(6): 710-717.
[55]
Terada T, Yamaga H, Tsumoto T, et al. Use of an embolic protection system during endovascular recanalization of a totally occluded cervical internal carotid artery at the chronic stage. Case report[J]. Journal of Neurosurgery, 2005, 102 (3): 558-564.
[56]
Kao HL, Lin MS, Wang CS, et al. Feasibility of endovascular recanalization for symptomatic cervical internal carotid artery occlusion[J]. Journal of the American College of Cardiology, 2007, 49(7): 765-771.
[57]
Lin MS, Lin LC, Li HY, et al. Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion[J]. Circ Cardiovasc Interv, 2008, 1(2): 119-125.
[58]
Shojima M, Nemoto S, Morita A, et al. Protected endovascular revascularization of subacute and chronic total occlusion of the internal carotid artery[J]. American Journal of Neuroradiology, 2010, 31(3): 481-486.
[59]
Terada T, Okada H, Nanto M, et al. Endovascular recanalization of the completely occluded internal carotid artery using a flow reversal system at the subacute to chronic stage[J]. J Neurosurg, 2010, 112(3): 563-571.
[60]
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, 18(1): 25-32.
[61]
Ogawa A, Yoshimoto T, Sakurai Y. Clinical analysis of STA-SCA bypass for vertebrobasilar occlusive disease[J]. The Tohoku Journal of Experimental Medicine, 1991, 164(3): 183-190.
[62]
Yu W, Kostanian V, Fisher M. Endovascular recanalization of basilar artery occlusion 80 days after symptom onset[J]. Stroke, 2007, 38(4): 1387-1389.
[63]
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.
[64]
He Y, Wang Z, Li T, et al. Preliminary findings of recanalization and stenting for symptomatic vertebrobasilar artery occlusion lasting more than 24 h: a retrospective analysis of 21 cases[J]. Eur J Radiol, 2013, 82(9): 1481-1486.
[65]
Akins PT, Amar AP, Pakbaz RS, Fields JD. Complications of endovascular treatment for acute stroke in the SWIFT trial with solitaire and Merci devices[J]. American Journal of Neuroradiology, 2014, 35(3): 524-528.
[66]
刘磊磊，汤其强，肖晗, 等. 脑保护装置在颈动脉支架中临床应用[J]. 临床神经病学杂志, 2014, 27(5): 389-391.
[67]
Miyazaki Y, Mori T, Iwata T, et al. Continuous daily use of cilostazol prevents in-stent restenosis following carotid artery stenting:serial angiographic investigation of 229 lesions[J].J Neurointerv Surg, 2016, 8(5): 471-475.
[68]
李钊硕. Wingspan支架治疗症状性颅内动脉严重狭窄的临床研究[D]. 郑州大学, 2009.
[69]
贺迎坤. 血管腔内再通术在非急性期颅内椎基底动脉闭塞中的应用研究[D]. 郑州大学, 2013.
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