Uz Zühre, Milstein Dan M J, Ince Can, de Mol Bastian A J M
Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Oral & Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
J Thromb Thrombolysis. 2017 Jul;44(1):14-18. doi: 10.1007/s11239-017-1509-x.
Postoperative stroke and encephalopathy are potentially serious complications associated with coronary artery bypass grafting. In this case report a 78-year-old male patient receiving routine elective cardiac surgery presented with microaggregations in the sublingual microcirculation while on cardiopulmonary bypass that was undetected by routine intraoperative anticoagulation assessment. Microaggregates identified using video microscopy on his sublingual microcirculation during the procedure preceded a stroke postoperatively. Postoperative cerebral and carotid artery examination with computed tomography scanning revealed a left watershed cerebral infarct with carotid stenosis. This report presents intraoperative microcirculation-based evidence suggesting that observations of microaggregations, otherwise undetected by conventional anticoagulation assessment techniques, could serve as an early warning in elderly patients at high risk for postoperative cerebrovascular events.
术后中风和脑病是冠状动脉搭桥手术潜在的严重并发症。在本病例报告中，一名接受常规择期心脏手术的78岁男性患者在体外循环期间舌下微循环出现微聚体，而常规术中抗凝评估未检测到。术中通过视频显微镜在其舌下微循环中识别出的微聚体先于术后中风出现。术后通过计算机断层扫描对大脑和颈动脉进行检查，发现左侧分水岭脑梗死伴颈动脉狭窄。本报告提供了基于术中微循环的证据，表明常规抗凝评估技术未检测到的微聚体观察结果可作为术后脑血管事件高危老年患者的早期预警。
