补救性血管内治疗在颅内动脉取栓术后狭窄中的研究进展
Research Progress of Rescue Endovascular Treatment for Stenosis after Intracranial Arterial Thrombectomy
摘要: 颅内动脉粥样硬化性狭窄(Intracranial atherosclerotic stenosis, ICAS)是造成急性缺血性卒中机械取栓再通失败或术后早期再闭塞的核心病因，这一问题在亚裔患者中尤为棘手。据多项临床研究统计，约有12%至41%的患者经机械取栓后无法获得满意的血管再通，而ICAS相关闭塞的即时再闭塞风险更是远超心源性栓塞。球囊扩张术、急性支架置入术及糖蛋白IIb/IIIa受体拮抗剂(以替罗非班为代表)作为补救性血管内治疗(rescue endovascular treatment, REVT)的三大策略，已在临床中积累了大量实践经验。观察性研究和荟萃分析总体支持REVT对取栓失败者的功能预后具有改善作用，但首个大型随机对照试验ANGEL-REBOOT的90天数据并未呈现出统计学差异；有趣的是，其一年随访却揭示了显著的远期获益。围绕这一“短期中性、长期有益”的矛盾结果，学术界展开了广泛讨论。本综述从ICAS相关闭塞的病理生理特征出发，逐一梳理各类补救手段的循证依据，兼论围手术期抗血小板方案的争议焦点、荟萃分析的异质性问题及在研临床试验的最新动态，并对未来研究方向提出更具针对性的设计思路。
Abstract: Intracranial atherosclerotic stenosis (ICAS) stands as a pivotal contributor to recanalization failure or early reocclusion following mechanical thrombectomy for acute ischemic stroke, posing a particularly formidable challenge among Asian populations. Statistics from multiple clinical investigations indicate that roughly 12% to 41% of patients do not achieve satisfactory vessel patency after thrombectomy, with ICAS-related occlusions carrying a substantially elevated risk of immediate reocclusion compared with cardioembolic etiologies. Balloon angioplasty, acute rescue stenting, and glycoprotein IIb/IIIa receptor antagonists (notably tirofiban) constitute three principal rescue endovascular strategies that have accumulated considerable clinical experience. Observational data and pooled analyses broadly support functional benefits of rescue treatment in patients with thrombectomy failure; nonetheless, the landmark ANGEL-REBOOT randomized trial revealed no significant difference at 90 days, while its one-year followup uncovered meaningful long-term advantages. The paradox of “short-term neutrality versus long-term benefit” has sparked extensive scholarly discourse. This review delineates the pathophysiological underpinnings of ICAS-related occlusions, appraises the evidence base for each rescue modality, examines controversies surrounding periprocedural antiplatelet regimens and the heterogeneity of meta-analyses, and highlights ongoing trial developments as well as more targeted design ideas for future research directions.
文章引用：乔恒通, 刘永军. 补救性血管内治疗在颅内动脉取栓术后狭窄中的研究进展[J]. 临床医学进展, 2026, 16(5): 2733-2743. https://doi.org/10.12677/acm.2026.1652084

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