Syed Tariqshah M, Halperin Jonathan L
Department of Cardiology, Zena and Michael A Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Nat Clin Pract Cardiovasc Med. 2007 Aug;4(8):428-35. doi: 10.1038/ncpcardio0933.
Atrial fibrillation (AF) is a major risk factor for disabling ischemic strokes. Anticoagulation is highly effective for stroke prevention in patients with AF, but a substantial number of patients are unable to sustain chronic therapy with warfarin. Most strokes in patients with AF are thought to arise from thrombus formation in the left atrial appendage (LAA); therefore, occlusion of the orifice of the LAA provides a theoretically appealing option for stroke prevention. Surgical exclusion of the LAA is increasingly performed in patients undergoing open-heart surgery, and thoracoscopic epicardial occlusion of the LAA has yielded promising early results. Percutaneous LAA occlusion devices have shown some success initial trials, but additional safety and efficacy data are required before this approach can be routinely considered. Here we discuss the LAA in relation to AF-related embolic stroke, and how LAA occlusion devices could be used in stroke prevention in patients who cannot tolerate chronic anticoagulant therapy.
心房颤动（AF）是导致缺血性中风致残的主要危险因素。抗凝治疗对预防房颤患者中风非常有效，但相当多的患者无法坚持长期服用华法林。大多数房颤患者的中风被认为是由左心耳（LAA）血栓形成引起的；因此，封堵LAA开口在理论上是一种有吸引力的预防中风的选择。在接受心脏直视手术的患者中，越来越多地采用手术切除LAA，而胸腔镜下心外膜封堵LAA已取得了令人鼓舞的早期结果。经皮LAA封堵装置在初步试验中已显示出一定成效，但在这种方法能够被常规应用之前，还需要更多的安全性和有效性数据。在此，我们讨论与房颤相关栓塞性中风有关的LAA，以及LAA封堵装置如何用于无法耐受长期抗凝治疗患者的中风预防。
