Oxley Thomas J, Dowling Richard J, Mitchell Peter J, Davis Stephen, Yan Bernard
Department of Neurology, The Royal Melbourne Hospital Melbourne, VIC, Australia.
Front Neurol. 2011 Dec 26;2:83. doi: 10.3389/fneur.2011.00083. eCollection 2011.
Antiplatelet resistance is emerging as a significant factor in effective secondary stroke prevention. Prevalence of aspirin and clopidogrel resistance is dependent upon laboratory test and remains contentious. Large studies in cardiovascular disease populations have demonstrated worse ischemic outcomes in patients with antiplatelet resistance, particularly in patients with coronary stents. Thromboembolism is a complication of neurointerventional procedures that leads to stroke. Stroke rates related to aneurysm coiling range from 2 to 10% and may be higher when considering silent ischemia. Stroke associated with carotid stenting is a major cause of morbidity. Antiplatelet use in the periprocedure setting varies among different centers. No guidelines exist for use of antiplatelet regimens in neurointerventional procedures. Incidence of stroke in patients post procedure may be partly explained by resistance to antiplatelet agents. Further research is required to establish the incidence of stroke in patients with antiplatelet resistance undergoing neurointerventional procedures.
抗血小板抵抗正逐渐成为有效的二级卒中预防中的一个重要因素。阿司匹林和氯吡格雷抵抗的发生率取决于实验室检测，且仍存在争议。针对心血管疾病人群的大型研究表明，抗血小板抵抗患者的缺血性结局更差，尤其是冠状动脉支架置入患者。血栓栓塞是神经介入手术的一种并发症，可导致卒中。与动脉瘤栓塞相关的卒中发生率为2%至10%，若考虑无症状性缺血，发生率可能更高。与颈动脉支架置入相关的卒中是发病的主要原因。围手术期抗血小板药物的使用在不同中心存在差异。目前尚无神经介入手术中抗血小板治疗方案使用的指南。术后患者的卒中发生率可能部分归因于对抗血小板药物的抵抗。需要进一步研究以确定接受神经介入手术的抗血小板抵抗患者的卒中发生率。
