冠状动脉和结构性心脏干预中的脑栓塞风险:临床证据
Daniela Tirziu1, Haocheng Huang1, Helen Parise1
1Yale Cardiovascular Research Group, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
概括
在美国,每年有近200万患者接受心脏手术,数千人面临中风风险,超过33万人面临缺血性脑损伤. 这凸显了这些干预措施造成的阴性脑损伤的重大风险.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 干预心脏病学 干预心脏病学
背景情况:
- 心脏干预,包括手术和透导管程序,携带急性中风和神经认知障碍的风险.
- 超导管大动脉置换已经增加了对手术相关的神经损伤和对栓塞保护的需要的关注.
- 越来越多的心脏手术加剧了人们对阳性脑损伤的担忧,特别是在高风险人群中.
研究的目的:
- 审查目前对心脏干预后阴性脑栓塞和缺血性心脏病发作的估计.
- 评估冠状动脉疾病,膜和其他心脏结构干预后脑损伤的发生率.
- 为了强调与增加心脏手术体积相关的神经风险的意义.
主要方法:
- 审查现有的文献和有关神经损伤发生率的数据.
- 对阴性脑栓塞和缺血性心脏病发作估计的分析.
- 检查与冠状动脉疾病,大动脉/心心门狭窄,心房动,左心房附属物关闭和圆孔关闭干预措施相关的数据.
主要成果:
- 在美国,每年大约有200万患者接受心脏干预.
- 估计有8000名患者在手术后面面临症状性中风的风险.
- 超过33万名患者 (95% CI,249,948-430,377) 面临缺血性脑损伤的风险.
结论:
- 由于越来越多地使用心脏手术,造成阴性脑栓塞的风险很大.
- 神经和认知评估对于进行这些干预的患者的管理至关重要.
- 需要适当的风险减轻策略来解决与程序相关的大脑损伤的潜在问题.
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