Werner Nicolas, Zahn Ralf, Zeymer Uwe
Klinikum Ludwigshafen, Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany.
Expert Rev Cardiovasc Ther. 2012 Oct;10(10):1297-305. doi: 10.1586/erc.12.78.
In the present day, coronary angiography and percutaneous coronary intervention are considered to be safe procedures with low complication rates in general. Nevertheless due to their widespread use and their application in a continually aging population known to carry a higher risk for complications, periprocedural stroke affects thousands of patients undergoing coronary angiography and percutaneous coronary intervention worldwide every year. Stroke is reported to occur in 0.05-0.1% of diagnostic cardiac catheterizations and in 0.18-0.44% of patients treated with percutaneous coronary intervention in clinical routine today. Despite all improvements in pharmacological and technical issues, the rate of stroke after cardiac catheterization has remained almost constant over the last 20 years of invasive cardiology of invasive and interventional cardiology, which is most probably due to the immutability of the majority of risk factors before cardiac procedures. An advanced age, arterial hypertension, diabetes mellitus, coronary angiography performed under emergency conditions, history of stroke, renal failure, the use of an intra-aortic balloon pump, congestive heart failure and interventions at bypass grafts have been identified as risk factors for periprocedural stroke in large registries. Due to exceedingly high rates of mortality and disability stroke after coronary angiography still has an enormous impact on the patient's prognosis and on quality of life. If patients survive this devastating complication, most of them suffer from persistent neurological deficits such as motor or speech disorders. For its low incidence and consecutively missing data from randomized clinical trials, an evidence-based treatment could not yet be established, and treatment options are generally based on case series and small studies only. Nevertheless, intra-arterial thrombolysis and mechanical embolectomy seem to be promising and relatively safe approaches in the treatment of periprocedural ischemic stroke. Further research by randomized trials and large registries are needed to validate its efficacy and safety.
如今，冠状动脉造影和经皮冠状动脉介入治疗总体上被认为是安全的手术，并发症发生率较低。然而，由于它们的广泛应用以及在不断老龄化且并发症风险较高的人群中的应用，围手术期卒中每年影响着全球数千名接受冠状动脉造影和经皮冠状动脉介入治疗的患者。据报道，在临床常规诊断性心导管检查中，卒中发生率为0.05 - 0.1%，在接受经皮冠状动脉介入治疗的患者中为0.18 - 0.44%。尽管在药理学和技术方面有了所有改进，但在过去20年的侵入性和介入性心脏病学中，心导管检查后卒中的发生率几乎保持不变，这很可能是由于大多数心脏手术前风险因素的不可改变性。高龄、动脉高血压、糖尿病、在紧急情况下进行的冠状动脉造影、卒中病史、肾衰竭、主动脉内球囊泵的使用、充血性心力衰竭以及旁路移植术的干预已被确定为大型登记研究中围手术期卒中的风险因素。由于冠状动脉造影后极高的死亡率和致残率，卒中仍然对患者的预后和生活质量产生巨大影响。如果患者在这种毁灭性并发症中幸存下来，他们中的大多数会患有持续性神经功能缺损，如运动或言语障碍。由于其发病率低且随机临床试验中连续数据缺失，尚未建立基于证据的治疗方法，治疗选择通常仅基于病例系列和小型研究。尽管如此，动脉内溶栓和机械取栓似乎是治疗围手术期缺血性卒中的有前景且相对安全的方法。需要通过随机试验和大型登记研究进行进一步研究，以验证其有效性和安全性。
