1
急性缺血性卒中
2019年公布的COMPASS研究中，270例直接血栓抽吸的前循环缺血性卒中患者，3个月的良好预后（mRS0-2）并不劣于支架取栓术，并且减少了手术时间和设备操作成本，其结果支持将直接抽吸作为代替支架取栓的更加经济有效的方法[1]。在2019版更新的急性缺血性卒中指南中也明确指出“推荐不逊于支架取栓器的直接抽吸术作为首过机械取栓术（I级推荐，B-R级证据）”[2]。
针对具有大面积梗死的卒中，也有新的证据表明血管内治疗可使这部分患者获益。对于前循环大动脉闭塞且ASPECTS评分≤ 5伴或不伴核心梗死≥50cm³的患者，EVT可降低梗死体积增长的幅度及最终梗死体积[3]，提高90天良好预后率，改善NIHSS评分，有更低的死亡趋势，同时出血风险无显著增加[4]。
在后循环大血管再通方面，东部战区总医院的刘新峰教授团队牵头的急性椎基底动脉闭塞性卒中血管再通研究（BEST）发表，结果提示联合介入治疗优于单纯药物治疗，该研究填补了椎基底动脉血管再通的国际空白[5]。
随着急性缺血性卒中研究的进一步推进，越来越多的问题将被解决，越来越多的患者也将获益。
2
颅内动脉粥样硬化狭窄
3
颅内动脉瘤血流导向
血流导向装置的进展主要聚焦在两个方面。首先，拥有更细释放系统外径（low profile）的血流导向装置层出不穷，包括各系列瘤外血流导向装置以及WEB17等瘤内扰流装置，更细释放系统外径可实现在更远的血管分支进行动脉瘤血流导向的治疗，或可避免许多经典复杂技术的固有风险。另一方面，血流导向装置的材质修饰技术改进，比如拥有Shield技术的Pipeline Flex血流导向系统，未来可以减少患者术后双抗持续时间[7]。而使用生物可吸收材料的血流导向装置的研发，以期提高动脉瘤愈合的同时，支架可自身降解，减少高金属覆盖率的远期影响[8]。
4
脑动静脉畸形
5
静脉窦疾病的血管内介入治疗
6
神经介入的OCT使用
7
神经介入领域的人工智能
在即将过去的2019年，神经介入领域日新月异，进展飞速，让我们拭目以待2020年的精彩！
参考文献
1. Turk AS, 3rd, Siddiqui A, FifiJT, et al. Aspiration thrombectomy versus stent retriever thrombectomy asfirst-line approach for large vessel occlusion (COMPASS): a multicentre,randomised, open label, blinded outcome, non-inferiority trial. Lancet 2019; 393(10175): 998-1008.
2. Powers WJ, Rabinstein AA, Ackerson T, et al.Guidelines for the Early Management of Patients With Acute Ischemic Stroke:2019 Update to the 2018 Guidelines for the Early Management of Acute IschemicStroke: A Guideline for Healthcare Professionals From the American HeartAssociation/American Stroke Association. Stroke2019; 50(12): e344-e418.
3. Sarraj A, Hassan AE, Savitz S, et al.Outcomes of Endovascular Thrombectomy vs Medical Management Alone in PatientsWith Large Ischemic Cores: A Secondary Analysis of the Optimizing Patient'sSelection for Endovascular Treatment in Acute Ischemic Stroke (SELECT) Study. JAMA neurology 2019.
4. Kakita H, Yoshimura S, Uchida K, et al.Impact of Endovascular Therapy in Patients With Large Ischemic Core:Subanalysis of Recovery by Endovascular Salvage for Cerebral Ultra-AcuteEmbolism Japan Registry 2. Stroke2019; 50(4): 901-8.
5. Liu X, Dai Q, Ye R, et al. Endovasculartreatment versus standard medical treatment for vertebrobasilar artery occlusion(BEST): an open-label, randomised controlled trial. The Lancet Neurology 2019.
6. Alexander MJ, Zauner A, Chaloupka JC, et al.WEAVE Trial: Final Results in 152 On-Label Patients. Stroke 2019; 50(4):889-94.
7. Trivelato FP, Wajnberg E, Rezende MTS, et al.Safety and Effectiveness of the Pipeline Flex Embolization Device With ShieldTechnology for the Treatment of Intracranial Aneurysms: Midterm Results From aMulticenter Study. Neurosurgery 2019.
8. Jamshidi M, Rajabian M, Avery MB, et al. Anovel self-expanding primarily bioabsorbable braided flow-diverting stent foraneurysms: initial safety results. Journalof neurointerventional surgery 2019.
9. Gory B, Berge J, Bonafe A, et al. FlowDiverters for Intracranial Aneurysms: The DIVERSION National Prospective CohortStudy. Stroke 2019; 50(12): 3471-80.
10. Hong T, Yan Y, Li J, et al. High prevalence ofKRAS/BRAF somatic mutations in brain and spinal cord arteriovenousmalformations. Brain : a journal ofneurology 2019; 142(1): 23-34.
11. Gounis MJ, Ughi GJ, Marosfoi M, et al.Intravascular Optical Coherence Tomography for Neurointerventional Surgery. Stroke 2018: STROKEAHA118022315.
12. Sundaram VK, Goldstein J, Wheelwright D, etal. Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CTPerfusion. AJNR American journal ofneuroradiology 2019; 40(12):2033-8.
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