ptas及内科治疗对症状性颅内动脉粥样硬化性狭窄疗效的对比研究神经病学专业论文.docxVIP

第三军医大学硕士学位论文The 第三军医大学硕士学位论文 The Comparative Study of PTAS and medical management 0n symptomatic intracranial ather0SClerotlC stenosis Abstract Background：Stroke is a common and frequently—occurring disease in China．It has the features of high morbidity，high disability，high mortality，high recurrence rate，and high economic burden． Intracranial atherosclerotic stenosis(ICAS)is the most important factor leading to ischemic stroke，more commonly in Asians．Since the patients of Asian are at higher risk of ICAS，it highlights the need for the diagnosis and treatment of ICAS in the prevention and treatment of ischemic stroke in China． According to whether there is ischemic stroke or transient ischemic attacks(TIA) occurring in the vascular territory of the stenosed or occluded artery，ICAS is classified into two types：one is symptomatic intracranial atherosclerotic stenosis(slCAS)and the other is asymptomatic intracranial atherosclerotic stenosis(alCAS)．slCAS has an high recurrence rate and has a positive correlation with the degree of arterial stenosis． The treatment of slCAS remains controversial nowadays．The WASID(Warfarin versus Aspirin Symptomatic Intracranial Disease Study for Stroke)study showed that the mean follow-up 1．8 year recurrence rate of slCAS Patients with 70％to 99％stenosis remained as high as 1 9％despite of undertaking medical therapytq．Alternative treatments， such as percutaneous transluminal angioplasty and stenting(PTAS)，may be one of the effective methods for these patients．Moreover，some non—randomized studies had encouraging data regarding potential safety and efficacy for PTAS in slCAS o川．However， enrollment in SAMMPRIS(Stenting versus aggressive medical therapy for intracranial arterial stenosis)study was stopped in advance in 20 1 1 because the 30-day rate of the primary endpoint event was significantly higher in the stenting aim than that in the medical aim(14．7％versus 5．8％)p1．As the SAMMPRIS study is the first multicenter prospective randomized con