症状性颅内动脉狭窄患者的最佳药物治疗课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,症状性颅内动脉狭窄患者的最佳药物治疗,武汉大学中南医院,Valadon onry.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,过去,我们只能通过尸检来观察动脉,粥样硬化的形态.,Thrombus,Fibrous,cap,Lipid,core,FJ Schoen,日MH,在过去,我们只能通过尸检观察动脉粥样硬化的形态。其他原因的动脉狭窄更是无,从检测。,images.medscapecom/pi/editorial/cmecircle/2019/3598/images/libby,Valadon onry.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,现代血管影像学技术的发展,为观察动脉狭窄形态提供了直观证据,颈动脉斑块总体面积,(TPA),Mean =0.84 mm,颈动脉内膜厚度,(cMT)B超,定量冠脉造影,EEM面积,颈总,官腔面积,动脉,斑块面积,颅外动脉,血管内超声(Us,核磁共振成像(MR|),Valadon onry.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,充分、正确利用各脑血管检査手段来,明确缺血性卒中的病理基础,VSI TCD,CTA,DSA,Evaluauon onr.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,脑动脉狭窄:缺血性卒中的重要病因,动脉粥样血栓形成堵塞,硬化斑块,血栓栓塞,3,中国缺血性卒中/TA患者50%存在颅内外动脉狭窄,Lawrence K.S. ong. International Journal of stroke 2019; 1(3): 158-159,malagony,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,脑动脉狭窄是血管事件和死亡的独立,危险因素,No. of,No, of furthe,Eventsor,n(%),Death, n(%),No vascular lesion,360(51.1),35(97),Intracranial vascular lesion only,258(37),47(18),Extracranial vascular lesion only,16(2.3),Both intracranial and extracranial lesions 71(10),16(23),Total,705(1000,98,血管事件和死亡风险,同时存在颅内和颅外动脉狭窄仅存在颅内动脉狭窄仅存在颅外动脉狭窄,Stroke2000;31:2641-7,Valadon onry.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,狭窄动脉数量越多,风险越大,复发风险最高,可达50%,在有血管病变的卒中患者中,狭窄血管的平均数量为2.7支,最多为9支。,随着狭窄血管数量增加,卒中患者发生血管事件或死亡的风险逐渐升高。,Stroke2000;31:2641-7,Valadon onry.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,颅内动脉狭窄越严重,卒中复发风险越大,025,70%,g,70%Ws70%,015,HR=2.08,P=00019,0.10,2,Years After Enrollment,No, at Risk,206,对WASD研究进行分析,在校正了年龄性别和种族后,颅内动脉狭窄严重程度是,狭窄动脉区域复发缺血性卒中的独立预测因素。,Kasner SE, et al. Circulation 2019; 113: 555-563,Valadon onry.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,颅内动脉粥样硬化的治疗措施,血压,强化他汀,血糖,危险因他汀,素控制,非药物抗栓,血管成形,抗血小板,(支架),抗凝,颅内外旁路,Valadon onry.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,抗栓治疗的选择,抗血小板还是抗凝?,颅内动脉狭窄支架治疗更有效吗?,传统抗血小板药物(阿司匹林)还是新型抗血,小板药物(氯吡格雷、西洛他唑)?,4|单药还是联合抗血小板治疗?,Valadon onry.,ch Asposeslides for NET 4o dient P,Evaluation only.,Created with Aspose Slides for NET 4.0 dient Profilo,71,Copyright 2019-2019Aspose Pty L,