颈动脉狭窄合并颅内动脉瘤的研究进展

Research Progress on Carotid Artery Stenosis Combined with Intracranial Aneurysm

摘要: 颈动脉狭窄合并颅内动脉瘤并非罕见，随着CTA、MRA及DSA等影像学检查技术的普及，其检出率逐渐升高。该类患者同时存在脑缺血及动脉瘤破裂出血风险，临床处理较单一病变更为复杂。既往研究提示，颈动脉狭窄与颅内动脉瘤可能共享高血压、吸烟、高龄及女性等危险因素，并在长期共同作用下形成系统性血管易损背景；此外，狭窄相关血流动力学异常可能通过影响壁面剪切应力及血管壁重塑，参与动脉瘤的形成或演变。在风险评估方面，目前仍应以动脉瘤大小、部位及形态等经典危险因素为基础，同时结合狭窄程度、症状状态及二者相对位置关系进行综合判断。治疗方面，分期治疗与同期治疗均有报道，优先处理狭窄或优先处理动脉瘤应根据缺血风险、出血风险、解剖特点及围术期操作风险个体化权衡。本文就颈动脉狭窄合并颅内动脉瘤的发生基础、风险评估及治疗策略选择的研究进展作一综述，以期为临床风险分层与个体化诊疗提供参考。

Abstract: Carotid artery stenosis combined with intracranial aneurysm is not uncommon, and its detection rate has gradually increased with the widespread use of imaging techniques such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA). These patients are simultaneously at risk of cerebral ischemia and aneurysmal rupture with hemorrhage, making clinical management more complex than that of a single lesion. Previous studies have suggested that carotid artery stenosis and intracranial aneurysm may share common risk factors, including hypertension, smoking, advanced age, and female sex, and may develop on the basis of a systemically vulnerable vasculature formed through their long-term combined effects. In addition, stenosis-related hemodynamic abnormalities may contribute to aneurysm formation or progression by affecting wall shear stress and vascular wall remodeling. In terms of risk assessment, evaluation should still be primarily based on classical aneurysm-related risk factors, such as aneurysm size, location, and morphology, while also taking into account the degree of stenosis, symptomatic status, and the relative anatomical relationship between the two lesions. Regarding treatment, both staged and simultaneous strategies have been reported. Whether priority should be given to the treatment of stenosis or aneurysm should be determined individually by balancing ischemic risk, hemorrhagic risk, anatomical characteristics, and perioperative procedural risk. This article reviews the research progress on the pathophysiological basis, rupture risk assessment, and treatment strategy selection for carotid artery stenosis combined with intracranial aneurysm, with the aim of providing a reference for clinical risk stratification and individualized management.