Time to Consider Pharmacologic Management of Unruptured Intracranial Aneurysms?

IF 8.6 1区 医学 Q1 CLINICAL NEUROLOGY
Yeon Soo Kim, Sungbin Hwang, Mi Hyeon Kim, Boseong Kwon, Yunsun Song, Deok Hee Lee
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引用次数: 0

Abstract

The increasing detection rate of unruptured intracranial aneurysms (UIAs) using advanced imaging underscores the need for alternative management strategies beyond surgical and endovascular interventions. Although these procedures have improved substantially, they still carry procedural risks, high costs, and psychological burdens related to continuous surveillance. This review aimed to suggest the potential role of pharmacological therapy in mitigating aneurysm progression and the risk of rupture. We first reviewed the key pathophysiological mechanisms-endothelial dysfunction, hemodynamic stress, inflammation, and thrombosis-contributing to UIA growth and instability. We then listed and examined a range of pharmacological agents, including antihypertensives, lipidlowering drugs, anti-inflammatory compounds, antioxidants, and novel candidates, summarizing both the preclinical and observational evidence supporting their use. While these findings are encouraging, current clinical data do not support broad, standardized treatment guidelines. Further prospective or randomized studies are required to clarify the safety, efficacy, and feasibility of using these agents in routine practice. By highlighting the rationale for pharmacological interventions and identifying key knowledge gaps, this review underscores the importance of an integrative management approach, encompassing medication, lifestyle modification, and vigilant monitoring, to better address patient needs and ultimately improve outcomes in UIA care.

是时候考虑未破裂颅内动脉瘤的药物治疗了?
先进成像技术对颅内未破裂动脉瘤(UIAs)的检出率越来越高,这表明除了手术和血管内干预外,还需要其他治疗策略。尽管这些程序有了很大的改进,但它们仍然存在程序风险、高成本和与持续监测有关的心理负担。本综述旨在提示药物治疗在缓解动脉瘤进展和破裂风险方面的潜在作用。我们首先回顾了导致UIA生长和不稳定的关键病理生理机制——内皮功能障碍、血流动力学应激、炎症和血栓形成。然后,我们列出并检查了一系列药理学制剂,包括降压药、降脂药、抗炎化合物、抗氧化剂和新的候选药物,总结了支持其使用的临床前和观察证据。虽然这些发现令人鼓舞,但目前的临床数据并不支持广泛、标准化的治疗指南。需要进一步的前瞻性或随机研究来阐明在常规实践中使用这些药物的安全性、有效性和可行性。通过强调药物干预的基本原理和确定关键的知识差距,本综述强调了综合管理方法的重要性,包括药物治疗、生活方式改变和警惕监测,以更好地满足患者的需求,并最终改善UIA护理的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Stroke
Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE
CiteScore
11.00
自引率
3.70%
发文量
52
审稿时长
12 weeks
期刊介绍: The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.
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