Moyamoya disease(MMD),characterized by progressive internal carotid artery stenosis and collateral vessel formation,prompts cerebral perfusion complications and is stratified into idiopathic and Moyamoya syndrome subt...Moyamoya disease(MMD),characterized by progressive internal carotid artery stenosis and collateral vessel formation,prompts cerebral perfusion complications and is stratified into idiopathic and Moyamoya syndrome subtypes.A multifa-ceted approach toward MMD management addresses cerebral infarctions through revascularization surgery and adjunctive medical therapy,while also navigating risks such as intracranial hemorrhage and cerebral infarction resulting from arte-rial stenosis and fragile collateral vessels.Addressing antithrombotic management reveals a potential role for treatments like antiplatelet agents and anticoagulants,despite the ambiguous contribution of thrombosis to MMD-related infarctions and the critical balance between preventing ischemic events and averting hemo-rrhagic complications.Transcranial doppler has proven useful in thromboembolic detection,despite persisting challenges concerning the efficacy and safety of an-tithrombotic treatments.Furthermore,antihypertensive interventions aim to ma-nage blood pressure meticulously,especially during intracerebral hemorrhage,with recommendations and protocols varying based on the patient’s hypertension status.Additionally,lipid-lowering therapeutic strategies,particularly employing statins,are appraised for their possible beneficial role in MMD management,even as comprehensive data from disease-specific clinical trials remains elusive.Com-prehensive guidelines and protocols to navigate the multifaceted therapeutic ave-nues for MMD,while maintaining a delicate balance between efficacy and safety,warrant further meticulous research and development.This protocol manuscript seeks to elucidate the various aspects and challenges imbued in managing and navigating through the complex landscape of MMD treatment.展开更多
Assessment of the overall risk of atherosclerotic cardiovascular disease(ASCVD)is the first step in managing dyslipidemia and is an important reference for the target and intensity of treatment.Recently,different guid...Assessment of the overall risk of atherosclerotic cardiovascular disease(ASCVD)is the first step in managing dyslipidemia and is an important reference for the target and intensity of treatment.Recently,different guidelines and consensuses on the management of this condition have successively recommended further risk stratification among patients with ASCVD,and a new“extreme risk”category has been proposed to identify patients who may obtain greater benefit from more intensive lipid-lowering therapy.The definition and terminology of extreme risk varies among different guidelines and consensuses;however,they all recommended an aggressive lipid-lowering therapeutic approach and/or a more stringent low-density lipoprotein cholesterol target for patients at extreme risk.Regardless of the definitions,this general approach may have a remarkable effect on the treatment of this condition in clinical practice.To help clinicians and patients to better understand the new strategy for the secondary prevention of ASCVD,this review provides a summary highlighting the necessity of further risk stratification among ASCVD patients,how patients at extreme risk can be identified,and the potential impact of applying the new“extreme risk”category in clinical practice.展开更多
文摘Moyamoya disease(MMD),characterized by progressive internal carotid artery stenosis and collateral vessel formation,prompts cerebral perfusion complications and is stratified into idiopathic and Moyamoya syndrome subtypes.A multifa-ceted approach toward MMD management addresses cerebral infarctions through revascularization surgery and adjunctive medical therapy,while also navigating risks such as intracranial hemorrhage and cerebral infarction resulting from arte-rial stenosis and fragile collateral vessels.Addressing antithrombotic management reveals a potential role for treatments like antiplatelet agents and anticoagulants,despite the ambiguous contribution of thrombosis to MMD-related infarctions and the critical balance between preventing ischemic events and averting hemo-rrhagic complications.Transcranial doppler has proven useful in thromboembolic detection,despite persisting challenges concerning the efficacy and safety of an-tithrombotic treatments.Furthermore,antihypertensive interventions aim to ma-nage blood pressure meticulously,especially during intracerebral hemorrhage,with recommendations and protocols varying based on the patient’s hypertension status.Additionally,lipid-lowering therapeutic strategies,particularly employing statins,are appraised for their possible beneficial role in MMD management,even as comprehensive data from disease-specific clinical trials remains elusive.Com-prehensive guidelines and protocols to navigate the multifaceted therapeutic ave-nues for MMD,while maintaining a delicate balance between efficacy and safety,warrant further meticulous research and development.This protocol manuscript seeks to elucidate the various aspects and challenges imbued in managing and navigating through the complex landscape of MMD treatment.
文摘Assessment of the overall risk of atherosclerotic cardiovascular disease(ASCVD)is the first step in managing dyslipidemia and is an important reference for the target and intensity of treatment.Recently,different guidelines and consensuses on the management of this condition have successively recommended further risk stratification among patients with ASCVD,and a new“extreme risk”category has been proposed to identify patients who may obtain greater benefit from more intensive lipid-lowering therapy.The definition and terminology of extreme risk varies among different guidelines and consensuses;however,they all recommended an aggressive lipid-lowering therapeutic approach and/or a more stringent low-density lipoprotein cholesterol target for patients at extreme risk.Regardless of the definitions,this general approach may have a remarkable effect on the treatment of this condition in clinical practice.To help clinicians and patients to better understand the new strategy for the secondary prevention of ASCVD,this review provides a summary highlighting the necessity of further risk stratification among ASCVD patients,how patients at extreme risk can be identified,and the potential impact of applying the new“extreme risk”category in clinical practice.
