Zhongguo cuzhong zazhi (Oct 2023)

无症状性颈内动脉狭窄和颅内动脉狭窄诊治进展 Advances in Study of Asymptomatic Carotid Artery Stenosis and Asymptomatic Intracranial Artery Stenosis

  • 李雯博，刘洁，刘阳，张龙友，李世平，郑华光

DOI
https://doi.org/10.3969/j.issn.1673-5765.2023.10.003
Journal volume & issue
Vol. 18, no. 10
pp. 1115 – 1120

Abstract

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本文探讨无症状性颈内动脉狭窄（asymptomatic carotid artery stenosis，aCAS）或无症状性颅内动脉狭窄（asymptomatic intracranial artery stenosis，aICAS）的优化筛查策略，以及基于分子标志物和影像学的精准预防策略。aCAS的患病率为1.5%，其风险评分有助于aCAS的筛查。aICAS患病率为6.9%～12.8%，与研究人群和筛查方法的不同有关。对于aCAS或aICAS患者，动脉管腔的狭窄程度和管壁的稳定性与卒中风险相关。新近的研究显示，动脉粥样硬化斑块内出血可增加卒中和冠心病的发病风险。aCAS或aICAS降低脑血流、脑灌注，增加1～3倍的痴呆或认知障碍风险。对于aCAS患者，随着药物治疗的优化和进展，颈动脉内膜剥脱术或颈动脉支架置入术治疗的相对获益需要再评价，选择合适的患者和减少手术并发症非常关键。对于aICAS患者，特别是严重狭窄或多发狭窄、进展性颅内动脉粥样硬化疾病、aICAS远端供血区域存在静止性脑梗死的患者，抗血小板和他汀类药物治疗可能获益，但需权衡出血和其他风险。 Abstract: To discuss the optimizing strategy in screening for the asymptomatic carotid artery stenosis (aCAS) or asymptomatic intracranial artery stenosis (aICAS) and the precise strategy in prevention for stroke based on the biomarkers and the imaging manifestations. The prevalence of aCAS was about 1.5% and the risk scores of aCAS were helpfull in the screening. The prevalence of aICAS was 6.9%～12.8%, according to the different study population and the screening tools. In patients with aCAS or aICAS, the severity of the vascular stenosis and the stability of the tube wall will affect the risk for stroke. Intraplaque hemorrhage was proved to increase the risk of incidence in stroke or coronary heart disease in the recent study. The cerebral blood flow and the cerebral perfusion decreased in the patients with aCAS or aICAS, which increased the risk of dementia or cognitive impairment with one to three times. Whether the patients with aCAS will benefit from carotid endarterectomy (CEA) or carotid artery stenting (CAS) need reevaluation as the drug therapy has made great progress. It play an important role to select a suitable patient and to reduce the complication of operation when making decisions. For the patients with aICAS, especially those with severe stenosis or multiple stenosis, progressive intracranial atherosclerosis disease, silent brain infarction within the brain territory distal to the aICAS, antiplatelet therapy and statins could be beneficial, with the consideration of cerebral hemorraghe or other adverse effects.

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