在接受过导管大动脉置换的患者中发生的脑血管事件:一篇评论
Kush P Patel1,2, Krishnaraj S Rathod2,3, Alexandra J Lansky4
1Institute of Cardiovascular Science, University College London, UK (K.P.P.).
Stroke
|October 7, 2024
概括
跨导管大动脉置换 (TAVR) 后的大脑血管事件 (CVEs) 是一个重大问题. 虽然中风发生率有所下降,但需要进一步的研究来预防这些并发症并改善患者的治疗结果.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 医疗成像医学成像
背景情况:
- 脑血管事件 (CVEs) 是通过导管的大动脉置换 (TAVR) 后的一个严重并发症.
- 尽管有所改善,但CVE仍然是一个问题,特别是随着TAVR使用率的增加.
- 在TAVR期间或之后,心血管瘤可能发生,与膜血栓形成,心房动和其他因素有关.
研究的目的:
- 审查TAVR患者中CVE的发病率,机制和潜在的预防策略.
- 评估大脑栓塞保护装置和抗凝固疗法的作用.
- 突出风险分层对于个性化的CVE预防的重要性.
主要方法:
- 对TAVR相关的CVE现有文献的审查.
- 对从临床试验中调查栓塞保护装置的数据进行分析.
- 检查成像发现 (例如,CT扫描) 的亚临床心脏病发作和膜血栓形成.
主要成果:
- 在TAVR之后,亚临床脑梗塞的高患病率 (68%-98%).
- 临床上明显的CVE发病率在1%至5%之间,取决于患者的风险.
- 栓塞保护装置显示出降低病变体积的潜力,但没有降低整体中风率.
- 栓血栓发生在10-15%的患者中,并且与增加的CVE风险有关.
- 与抗血小板治疗相比,抗凝药增加了出血风险,但没有显著减少血栓栓塞症.
结论:
- 风是TAVR的一个重大并发症,既有程序性原因,也有晚发病原因.
- 目前的栓塞保护装置缺乏强有力的证据来降低整体中风率.
- 风险分层对于为高风险TAVR患者量身定制预防疗法至关重要.
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