-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
*For medical professionals only
Intracranial atherosclerotic stenosis (ICAS), also known as intracranial atherosclerotic disease (ICAD), is a common cause of ischaemic stroke, and stroke patients with ICAS tend to have more severe symptoms, longer hospital stays, and are more likely to relapse.
However, in China, the incidence of ICAS in stroke/transient ischemic attack (TIA) patients is as high as 46.
6%.
Recently, the "Chinese Expert Consensus on the Endovascular Treatment of Symptomatic Intracranial Atherosclerotic Stenosis 2022" was released in the "Chinese Journal of Stroke", combined with the latest research results and expert opinions to give recommendations, covering the treatment of ICAS, restenosis and prevention, evaluation of endovascular therapy, and perioperative management.
It provides important guidance for precision treatment and secondary stroke prevention of ICAS patients, let's take a look!
have been
explored.
▌The study of internal medicine treatment of SAMMPRIS has laid the first-line position of intensive drug treatment in the prevention and treatment of
ICAS, including antiplatelet therapy, strengthening
lipid reduction, Control of risk factors and lifestyle changes, etc.
, therefore, consensus recommendation:
▌ Endovascular therapy For the endovascular treatment of sICAS, although it has become more cautious because of the negative results of comparing drugs and drugs combined with endovascular therapy
RCTs, it has been moving forward, such as the CASSISS study published by Chinese scholars this year (symptomatic intracranial artery stenosis, What are the advantages and disadvantages of drugs and stent combined drug therapy? China's latest research is coming! ）
。
In this regard, consensus recommends:
and monitoring
.
Restenosis is defined as a stenosis rate of >50% and absolute lumen >loss of 20% within a stent or adjacent range (within 5 mm), which has been a bottleneck problem that plagues balloon dilation/stenting in the treatment of arterial stenosis, especially severe intracranial vascular restenosis [within the stent or adjacent range (within 5 mm)].
Stricture rates > 70%, or an increase of >30%) from baseline diameter stenosis rates, are associated with
cerebral ischaemic symptoms and stroke recurrence.
In this regard, the consensus recommends:
(1) the risk of asymptomatic restenosis recurrence stroke is relatively low, and follow-up under drug treatment is recommended in principle; Patients with symptomatic severe restenosis that do not respond to medical therapy may be considered for vascular intervention (C-EO evidence, moderately recommended).
S.
Food and Drug Administration updated the scope of application of the Wingspan stent system in ICAS patients, recommending more rigorous screening of patients, endovascular therapy, as one of the treatment methods of sICAS, should also be selectively carried out in patients, and only patients who have passed rigorous preoperative evaluation screening can benefit from surgery
。
Preoperative evaluation includes: clinical characteristics of the patient, timing of surgery, classification of causes of ischemic stroke, vascular conditions (stenosis rate, location, length, morphology, angle, plaque nature, calcification grade, blood flow classification, pathway, distal guidewire landing area, lesion and branch relationship, combined with other vascular lesions, etc.
), cerebral collateral circulation, etc
.
In this regard, consensus recommends:
After reading the main expert opinions of the new version of the 2022 consensus, what do you think? Welcome to leave a message in the comment area to discuss
.
References:[1] Neurointerventional Branch of Chinese Stroke Society.
Chinese expert consensus on endovascular treatment of symptomatic intracranial atherosclerotic stenosis 2022[J].
Chinese Journal of Stroke,2022,17(08):863-888.
)
Where to see more neuroguides?
Come to the "Doctor Station" and take a look 👇
After 4 years, 20 opinions have been updated
Intracranial atherosclerotic stenosis (ICAS), also known as intracranial atherosclerotic disease (ICAD), is a common cause of ischaemic stroke, and stroke patients with ICAS tend to have more severe symptoms, longer hospital stays, and are more likely to relapse.
However, in China, the incidence of ICAS in stroke/transient ischemic attack (TIA) patients is as high as 46.
6%.
Recently, the "Chinese Expert Consensus on the Endovascular Treatment of Symptomatic Intracranial Atherosclerotic Stenosis 2022" was released in the "Chinese Journal of Stroke", combined with the latest research results and expert opinions to give recommendations, covering the treatment of ICAS, restenosis and prevention, evaluation of endovascular therapy, and perioperative management.
It provides important guidance for precision treatment and secondary stroke prevention of ICAS patients, let's take a look!
01
The treatment of ICAS mainly includes medical, surgical and endovascular treatment, surgical treatment due to its high complication, so far has not been recommended by global guidelines, medical treatment and endovascular treatmenthave been
explored.
▌The study of internal medicine treatment of SAMMPRIS has laid the first-line position of intensive drug treatment in the prevention and treatment of
ICAS, including antiplatelet therapy, strengthening
lipid reduction, Control of risk factors and lifestyle changes, etc.
, therefore, consensus recommendation:
(1) For patients with sICAS, aspirin-based antiplatelet therapy and intensive medical therapy should be initiated as soon as possible after the onset of illness (grade B-R evidence, strongly recommended).
(2) In the early stage of ICAS, dual antiplatelet therapy is recommended to reduce the risk
of early stroke recurrence caused by thromboembolism.
Aspirin and clopidogrel dual antiplatelet therapy is recommended for 90 days (grade B-NR evidence, moderately recommended); In patients resistant to clopidogrel (eg, with the CYP2C19 function deletion allele), ticagrelor plus aspirin is reasonable (grade B-NR evidence, weak recommendation) and cilostazol (200 mg/day) is reasonable (grade B-NR evidence, Medium recommendation).
(3) ICAS patients with hypertension should actively control their blood pressure, and the timing of antihypertensive therapy and the target value of blood pressure should be individualized
.
Unless special, the long-term blood pressure control target should be < 140/90mmHg, and the principle is gradual and stable blood pressure reduction</b11>
(4) It is recommended to start intensive lipid-lowering therapy early for ICAS patients (grade B-R evidence, strongly recommended); Statins are recommended to reduce LDL-C to <1.
8 mmol/L</b12> ( may be considered
(5) For patients with ICAS with diabetes, a glycemic control target of 7% glycosylated hemoglobin ≤ may be reasonable (B-NR level evidence, moderately recommended).
(6) Advocate a healthy lifestyle, moderate intensity exercise 3~5 times a week, control other risk factors to reduce the risk of stroke recurrence (B-NR level evidence, medium recommendation).
▌ Endovascular therapy For the endovascular treatment of sICAS, although it has become more cautious because of the negative results of comparing drugs and drugs combined with endovascular therapy
RCTs, it has been moving forward, such as the CASSISS study published by Chinese scholars this year (symptomatic intracranial artery stenosis, What are the advantages and disadvantages of drugs and stent combined drug therapy? China's latest research is coming! ）
。
In this regard, consensus recommends:
(1) Intensive medical treatment is the basic treatment of patients with sICAS, and patients with sICAS should receive intensive medical therapy (including antiplatelet therapy and control of risk factors) regardless of whether endovascular therapy is chosen (grade B-R evidence, strongly recommended).
(2) It is safe for trained physicians to perform stenting sICAS in a medical center with extensive experience if the patient meets the screening criteria, and can be considered as an effective and safe complementary treatment other than intensive medical therapy (B-R evidence, weak recommendation).
(3) For people at high risk of sICAS (ineffective after intensive medical therapy, severe stenosis, hypoperfusion in the responsible vascular supply area, collateral circulation poor compensation), the choice of stent placement for sICAS may be reasonable (C-LD grade evidence, weak recommendation).
(4) Based on current clinical experience and reports, self-expanding stents released through microcatheters reduce the difficulty of operation, help improve the success rate of technology and reduce the incidence of surgical complications, and the selective use of stents beyond instructions in the treatment of sICAS may be reasonable (C-EO level evidence, moderately recommended).
(5) The treatment of sICAS with balloon dilation alone may be safe and effective, and intracranial balloons and low-pressure, semi-compliant balloons can be preferred in treatment to improve the safety of surgery (C-LD level evidence, moderately recommended).
(6) In the operation of simple balloon dilation and shaping technology, it is recommended to slow filling and slow pressure relief, and after dilation, a longer period of blood flow observation should be carried out, and remedial stent placement should be carried
out in the presence of flow-limiting dissection or elastic retraction.
It is recommended that the balloon diameter be 50%~80% of the reference diameter of the responsible vessel (subsatisfactory dilation) (C-EO grade evidence, weak recommendation).
(7) Drug-coated stent treatment of sICAS may be a new treatment to
solve the problem of sICAS restenosis and stroke recurrence.
It can be selected according to the patient's specific lesion and pathway characteristics (grade B-R evidence, moderate recommendation).
(8) Drug-coated balloon treatment of sICAS may be a new treatment to
solve the problem of sICAS restenosis and stroke recurrence.
It can be selected according to the patient's specific lesion and pathway characteristics, and a higher level of evidence is required to confirm it (C-EO level evidence, weak recommendation).
(9) For patients with symptomatic restenosis, it is recommended to give preference to drug-coated stents for intracranial special treatment of sICAS (C-EO grade evidence, weak recommendation).
02
Definition and prevention of restenosis Like endovascular treatment of coronary artery stenosis, severe restenosis after balloon dilation/stent placement is an independent risk factor for stroke recurrence and poor prognosis in patients with sICAS, and should be focused on preventionand monitoring
.
Restenosis is defined as a stenosis rate of >50% and absolute lumen >loss of 20% within a stent or adjacent range (within 5 mm), which has been a bottleneck problem that plagues balloon dilation/stenting in the treatment of arterial stenosis, especially severe intracranial vascular restenosis [within the stent or adjacent range (within 5 mm)].
Stricture rates > 70%, or an increase of >30%) from baseline diameter stenosis rates, are associated with
cerebral ischaemic symptoms and stroke recurrence.
In this regard, the consensus recommends:
(1) the risk of asymptomatic restenosis recurrence stroke is relatively low, and follow-up under drug treatment is recommended in principle; Patients with symptomatic severe restenosis that do not respond to medical therapy may be considered for vascular intervention (C-EO evidence, moderately recommended).
03
Preoperative evaluation of endovascular therapy In 2012, the U.S.
Food and Drug Administration updated the scope of application of the Wingspan stent system in ICAS patients, recommending more rigorous screening of patients, endovascular therapy, as one of the treatment methods of sICAS, should also be selectively carried out in patients, and only patients who have passed rigorous preoperative evaluation screening can benefit from surgery
。
Preoperative evaluation includes: clinical characteristics of the patient, timing of surgery, classification of causes of ischemic stroke, vascular conditions (stenosis rate, location, length, morphology, angle, plaque nature, calcification grade, blood flow classification, pathway, distal guidewire landing area, lesion and branch relationship, combined with other vascular lesions, etc.
), cerebral collateral circulation, etc
.
In this regard, consensus recommends:
(1) Timing of surgery: endovascular therapy in patients with ICAS may be safe (except for progressive stroke) after at least 2 weeks of acute ischemic stroke (grade C-LD evidence, moderately recommended).
(2) Collateral circulation: For patients with ICAS, preoperative collateral circulation evaluation is beneficial to select suitable surgical patients, and patients with poor collateral circulation with preoperative imaging evaluation may be more suitable for endovascular therapy (C-LD grade evidence, moderately recommended).
(3) Individualized endovascular therapy for morphological analysis of the etiology and stenosis site of ICAS patients will have better benefits (C-EO level evidence, moderately recommended).
04
Perioperative management(1) Perioperative blood pressure management and antiplatelet and anticoagulant therapy applications have not been updated, the same as the 2018 version
.
(2) Perioperative anesthesia methods and complication management have not been updated, the same as the 2018 version
.
(3) The perioperative application of platelet membrane glycoprotein II.
b/III.
a receptor antagonists may be beneficial in reducing thrombotic complications, especially in preventing intraoperative acute stent thrombosis, but high-level clinical research evidence is still needed to confirm (C-LD grade evidence, weak recommendation).
After reading the main expert opinions of the new version of the 2022 consensus, what do you think? Welcome to leave a message in the comment area to discuss
.
References:[1] Neurointerventional Branch of Chinese Stroke Society.
Chinese expert consensus on endovascular treatment of symptomatic intracranial atherosclerotic stenosis 2022[J].
Chinese Journal of Stroke,2022,17(08):863-888.
)
Where to see more neuroguides?
Come to the "Doctor Station" and take a look 👇
