From the Cerebrovascular Center, Neurological Institute (S.-M.C., K.U.) and Medicine Institute (A.D.), Cleveland Clinic, OH; ProEd Communications Inc, Cleveland, OH (V.P.); School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (A.V.H.); School of Pharmacy, University of Connecticut, Storrs (A.V.H.); and Hartford Hospital Evidence-Based Practice Center, CT (A.V.H.).
Stroke. 2017 Oct;48(10):2753-2759. doi: 10.1161/STROKEAHA.117.017541. Epub 2017 Sep 15.
The incidence of periprocedural brain infarcts varies among cardiovascular procedures. In a systematic review, we compared the ratio of radiographic brain infarcts (RBI) to strokes and transient ischemic attacks across cardiac and vascular procedures.
We searched MEDLINE and 5 other databases for brain infarcts in aortic valve replacement, coronary artery bypass grafting, cardiac catheterization, and cerebral angiogram through September 2015. We followed the PRISMA (preferred reporting items for systematic reviews and meta-analyses) recommendations. We defined symptomatic rate ratio (RR) as ratio of stroke plus transient ischemic attack rate to RBI rate.
Twenty-nine studies involving 2124 subjects met the inclusion criteria. In meta-analysis of aortic valve replacements with 494 people, 69.4% (95% confidence interval (CI), 57.6%-81.4%) had RBIs, whereas 3.6% (95% CI, 2.0%-5.2%) had clinical events (RR, 0.08; 95% CI, 0.05-0.12). Coronary artery bypass grafting among 204 patients had 27.4% (95% CI, 6.0%-48.8%) RBIs and 2.4% (95% CI, 0.3%-4.5%) clinical events (RR, 0.11; 95% CI, 0.05-0.26). Cardiac catheterization among 833 people had 8.0% (95% CI, 4.1%-12.0%) RBIs, and 0.6% (95% CI, 0.1%-1.1%) had clinical events (RR, 0.16; 95% CI, 0.08-0.31). Cerebral angiogram among 593 people had 12.8% (95% CI, 6.6-19.0) RBIs and 0.6% (95% CI, 0%-13%) clinical events (RR, 0.10; 95% CI, 0.04-0.27). The RR of all procedures was 0.10 (95% CI, 0.07-0.13) without differences in the RRs across procedures (=0.29).
One of 10 people with periprocedural RBIs during cardiac surgeries and invasive vascular diagnostic procedures resulted in strokes or transient ischemic attacks, which may serve as a potential surrogate marker of procedural proficiency and perhaps as a predictor of risk for periprocedural strokes.
在心血管手术中，围手术期脑梗死的发生率各不相同。在一项系统评价中，我们比较了心脏和血管手术中放射性脑梗死（RBI）与卒中和短暂性脑缺血发作的比值。
我们检索了 MEDLINE 和其他 5 个数据库，以获取截至 2015 年 9 月的主动脉瓣置换术、冠状动脉旁路移植术、心导管术和脑血管造影术的脑梗死病例。我们遵循 PRISMA（系统评价和荟萃分析的首选报告项目）的建议。我们将症状性率比（RR）定义为卒中和短暂性脑缺血发作的发生率与 RBI 发生率的比值。
29 项研究共纳入 2124 例患者，符合纳入标准。在对 494 例接受主动脉瓣置换术的患者进行的荟萃分析中，69.4%（95%置信区间（CI），57.6%-81.4%）患者发生 RBI，3.6%（95% CI，2.0%-5.2%）发生临床事件（RR，0.08；95% CI，0.05-0.12）。在 204 例接受冠状动脉旁路移植术的患者中，27.4%（95% CI，6.0%-48.8%）发生 RBI，2.4%（95% CI，0.3%-4.5%）发生临床事件（RR，0.11；95% CI，0.05-0.26）。在 833 例接受心导管术的患者中，8.0%（95% CI，4.1%-12.0%）发生 RBI，0.6%（95% CI，0.1%-1.1%）发生临床事件（RR，0.16；95% CI，0.08-0.31）。在 593 例接受脑血管造影术的患者中，12.8%（95% CI，6.6-19.0%）发生 RBI，0.6%（95% CI，0%-13%）发生临床事件（RR，0.10；95% CI，0.04-0.27）。所有手术的 RR 为 0.10（95% CI，0.07-0.13），各手术之间的 RR 无差异（=0.29）。
在心脏手术和有创血管诊断性手术中，每 10 例围手术期 RBI 患者中就有 1 例发生卒中和短暂性脑缺血发作，这可能成为手术熟练程度的潜在替代标志物，或许也可预测围手术期卒中的风险。
