颅内动脉支架40页PPT
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大纲
• 颅内血管的特点 • TIA的病理生理 • 进展 • 治疗 • 有待探讨的问题
颅内血管的特点
– 血管与其相应供血区的关系 – 血管壁的结构 – 穿支的问题 – 血管走行特点
TIA的病理生理
– 大动脉狭窄型 – 栓塞型 – 腔隙型 – 混合型
进展
– 自然病程 – 药物治疗
• WASID
–Biblioteka Baidu支架治疗
A 69-yr-old man had chronic transient ischemia attacks due to severe stenosis of the intracranial portion of the right carotid artery. After failure of both antiplatelet and anticoagulant therapy, treatment was successful with percutaneous transluminal angioplasty and a coronary Palmaz-Schatz stent. Use of the stent led to a better angiographic result than angioplasty alone. The patient is asymptomatic 4 mo later.
– ipsilateral stroke or death rate of
30-d
4.4%
6-m
7.1%
进展
• 多中心、随机对照研究
进展
• As technology and experience evolve, this procedure is becoming increasingly effective and safe for the treatment of intracranial atherosclerotic disease, and guidelines are being developed for its use.
Pelz D, Advances in Interventional Neuroradiology 2019. Stroke. 2019;37:309-311.)
治疗
• 手术适应症 – TIAs or stroke attributed to intracranial stenoses of ≥ 50% diameter reduction – Evidences of atherosclerotic risk factors or dissection – Evidences of decreased perfusion distal to the stenosis
Cathet Cardiovasc Diagn. 2019 Jul;38(3):316-9
进展
进展
• SSYLVIA Trial
• WINGSPAN Trial （prospective, multicenter study ）
– selfexpanding microstent
– 45 patients with stenoses > 50%
Hartmann M, et al. Curr Op Neurol. 2019;18:39–45. AJNR Am J Neuroradiol. 2019;26:2323–2327.
进展
• Within peri-procedure
Stroke and death
8.3%
• Annual stroke
• Similar to revascularization for extracranial carotid artery stenosis, patient benefit from revascularization for symptomatic intracranial arterial stenosis is critically dependent on a low periprocedural stroke and death rate and should thus be performed by experienced neurointerventionists
AJNR Am J Neuroradiol. 2019;26:385–389.
进展
• Intracranial angioplasty with or without stenting should be offered to symptomatic patients with intracranial stenoses who have failed medical therapy
3% - 5%
Neurosurg Clin N Am. 2019;16:297–308. AJNR Am J Neuroradiol. 2019;26:525–530.
进展
• This procedure, however, remains hazardous with up to 50% of patients showing new, ipsilateral ischemic lesions on diffusion-weighted MR images.
J Vasc Interv Radiol 2019; 16:1281–1285
进展
• Drug-eluting stents, although showing promise in coronary and canine vessels for the prevention of restenosis, are still not ready for human cerebral arteries because of differing histology and questions of drug neurotoxicity.
• 首例 • 目前报道的小结
进展
• 第一例颅内动脉支架（2019年7月）
Use of coronary Palmaz-Schatz stent in the percutaneous treatment of an intracranial carotid artery stenosis Feldman RL, Trigg L, Gaudier J, Galat J. Ocala Heart Institute, Florida, USA.
• 颅内血管的特点 • TIA的病理生理 • 进展 • 治疗 • 有待探讨的问题
颅内血管的特点
– 血管与其相应供血区的关系 – 血管壁的结构 – 穿支的问题 – 血管走行特点
TIA的病理生理
– 大动脉狭窄型 – 栓塞型 – 腔隙型 – 混合型
进展
– 自然病程 – 药物治疗
• WASID
–Biblioteka Baidu支架治疗
A 69-yr-old man had chronic transient ischemia attacks due to severe stenosis of the intracranial portion of the right carotid artery. After failure of both antiplatelet and anticoagulant therapy, treatment was successful with percutaneous transluminal angioplasty and a coronary Palmaz-Schatz stent. Use of the stent led to a better angiographic result than angioplasty alone. The patient is asymptomatic 4 mo later.
– ipsilateral stroke or death rate of
30-d
4.4%
6-m
7.1%
进展
• 多中心、随机对照研究
进展
• As technology and experience evolve, this procedure is becoming increasingly effective and safe for the treatment of intracranial atherosclerotic disease, and guidelines are being developed for its use.
Pelz D, Advances in Interventional Neuroradiology 2019. Stroke. 2019;37:309-311.)
治疗
• 手术适应症 – TIAs or stroke attributed to intracranial stenoses of ≥ 50% diameter reduction – Evidences of atherosclerotic risk factors or dissection – Evidences of decreased perfusion distal to the stenosis
Cathet Cardiovasc Diagn. 2019 Jul;38(3):316-9
进展
进展
• SSYLVIA Trial
• WINGSPAN Trial （prospective, multicenter study ）
– selfexpanding microstent
– 45 patients with stenoses > 50%
Hartmann M, et al. Curr Op Neurol. 2019;18:39–45. AJNR Am J Neuroradiol. 2019;26:2323–2327.
进展
• Within peri-procedure
Stroke and death
8.3%
• Annual stroke
• Similar to revascularization for extracranial carotid artery stenosis, patient benefit from revascularization for symptomatic intracranial arterial stenosis is critically dependent on a low periprocedural stroke and death rate and should thus be performed by experienced neurointerventionists
AJNR Am J Neuroradiol. 2019;26:385–389.
进展
• Intracranial angioplasty with or without stenting should be offered to symptomatic patients with intracranial stenoses who have failed medical therapy
3% - 5%
Neurosurg Clin N Am. 2019;16:297–308. AJNR Am J Neuroradiol. 2019;26:525–530.
进展
• This procedure, however, remains hazardous with up to 50% of patients showing new, ipsilateral ischemic lesions on diffusion-weighted MR images.
J Vasc Interv Radiol 2019; 16:1281–1285
进展
• Drug-eluting stents, although showing promise in coronary and canine vessels for the prevention of restenosis, are still not ready for human cerebral arteries because of differing histology and questions of drug neurotoxicity.
• 首例 • 目前报道的小结
进展
• 第一例颅内动脉支架（2019年7月）
Use of coronary Palmaz-Schatz stent in the percutaneous treatment of an intracranial carotid artery stenosis Feldman RL, Trigg L, Gaudier J, Galat J. Ocala Heart Institute, Florida, USA.