颅内血管支架术.pptx

颅内血管支架术;Intracranial Atherosclerotic Disease颅内动脉狭窄性疾病 (ICAD);;;ICAD 治疗方案;6;ICAD药品治疗临床研究: WASID; WASID 主要终点 — 主要发觉 卒中发生率二者无显著差异 华法令所致出血和死亡发生率更高 Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial Stenosis; N ENGL J Med 352;13, March 31, 2023.;次要终点 临床决策分析：多变量分析 入选时与狭窄区域有关发生卒中危险原因，（临床评定） * Time from qualifying event median = 17 days (max = 90 days), early enrollment associated with greater risk, not confounded by gender or percent stenosis. ** Women have lower risk of stroke due to carotid disease and less benefit of CEA. Possible explanations: differential arterial anatomy, arterial size, body size and morphology, and hormonal factors, possible false positive association (Type I error). Requires further study. Presented February 4, 2023, American Stroke Association, New Orleans;ICAD药品治疗临床研究: WASID;外科治疗：颅内/颅外动脉搭桥;成果 主要发觉：颅内颅外搭桥术没有证明能减少颈内和MCA狭窄所致卒中 Note: Acute major stroke = period from randomization to 30 days after the actual surgery was completed. Failure of Extracranial-Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke: Results of an International Randomized Trial. N Engl J Med 1985; 313:1191–1200.;;;;支架成功 功能充足，狭窄不大于50% 操作成功率 支架成功释放且出院前未发生卒中或死亡 *Procedural means that the event occurred at the time of the procedure or within the same hospitalization but not in excess of 30 days within the same hospitalization. Source: Guidant SSYLVIA study results, Stroke. 2023;25:1388-1392. Guidant SSYLVIA trial. Summary of Safety and Probable Benefit (HDE, August 2023) ;SSYLVIA 六个月和一年成果 *6-month and one-year data **One-year data only Source: Guidant SSYLVIA study results, Stroke. 2023;25:1388–1392. Guidant SSYLVIA trial. Summary of Safety and Probable Benefit (HDE, August 2023);SSYLVIA 血管造影成果－颅内 Source: Guidant SSYLVIA study results, Stroke. 2023;25:1388–1392. Guidant SSYLVIA trial. Summary of Safety and Probable Benefit (HDE, August 2023);SSYLVIA 六个月再狭窄率(50% 狭窄) Guidant SSYLVIA trial. Summary of Safety and Probable Benefit (HDE, Augus