Vellieux G, Evrard S, Guedin P, Lapergue B
Unité de neurovasculaire, service de neurologie, hôpital Foch, université Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, université Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
Ann Cardiol Angeiol (Paris). 2014 Dec;63(6):428-36. doi: 10.1016/j.ancard.2014.09.029. Epub 2014 Oct 5.
Interventional cardiology procedures are regularly exposed to ischemic neurological complications. IV fibrinolysis is the only approved treatment in ischemic stroke but is very often contraindicated in these situations. Many techniques of interventional neuroradiology (mechanical thrombectomy) have been developed over the past years and are used to treat these patients.
We report the case of two patients who were admitted in emergency for ischemic stroke with contraindication to IV fibrinolysis (cardioversion for atrial fibrillation under anticoagulation; 24 hours after carotid surgery). These patients were treated by endovascular thrombectomy procedure.
After validation of IV fibrinolysis within 4.5 hours after stroke onset, techniques of mechanical thrombectomy have gradually been developed, either as a complementary treatment or as an alternative in the case of CI to fibrinolysis. These endovascular thrombectomy devices currently allow recanalization of proximal cerebral occlusions, which correlates with a favorable clinical prognosis. A review of the literature is provided, along with a discussion about the techniques currently being improved, their advantages and disadvantages and the selection of patients that can benefit from endovascular procedures.
In the case of a sudden occurrence of a neurological deficit during a cardiovascular procedure, a "thrombolysis alert" should be triggered. This will permit the rapid establishment of a clinico-radiological report for selecting stroke patients eligible for a procedure of recanalization by thrombolysis and/or mechanical thrombectomy.
介入心脏病学手术经常会面临缺血性神经并发症。静脉溶栓是缺血性卒中唯一被批准的治疗方法，但在这些情况下往往是禁忌的。在过去几年中，已经开发出许多介入神经放射学技术（机械取栓术）并用于治疗这些患者。
我们报告了两名因缺血性卒中紧急入院的患者，他们有静脉溶栓的禁忌证（抗凝治疗下房颤的心脏复律；颈动脉手术后24小时）。这些患者接受了血管内取栓手术治疗。
在卒中发作后4.5小时内静脉溶栓得到验证后，机械取栓技术逐渐得到发展，既作为辅助治疗，也作为溶栓禁忌时的替代治疗。这些血管内取栓装置目前能够使大脑近端闭塞再通，这与良好的临床预后相关。本文提供了文献综述，并讨论了目前正在改进的技术、它们的优缺点以及可从血管内手术中获益的患者的选择。
在心血管手术期间突然出现神经功能缺损的情况下，应触发“溶栓警报”。这将有助于快速建立临床放射学报告，以选择适合通过溶栓和/或机械取栓进行再通手术的卒中患者。
