Malikova Hana, Kremenova Karin, Budera Petr, Herman Dalibor, Weichet Jiri, Lukavsky Jiri, Osmancik Pavel
Department of Radiology, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Quant Imaging Med Surg. 2021 Jul;11(7):3219-3233. doi: 10.21037/qims-21-35.
Invasive treatments for atrial fibrillation (AF) pose a risk of ischemic stroke due to periprocedural brain embolization, which may be manifest or silent. The primary aim of our study was to compare the rate of silent strokes after percutaneous catheter-based and thoracoscopic epicardial ablation for AF. The secondary aim was to evaluate the development of silent strokes over time.
We included 39 subjects (aged 64.1±8.9 years) treated for persistent symptomatic AF with thoracoscopic ablation and 30 subjects (aged 64.1±10.5 years) treated for paroxysmal or persistent symptomatic AF with catheter ablation. Subjects underwent brain MRI before and early after the ablation, moreover, the surgical group underwent late MRI 6 months after therapy. On early MRI, the presence of silent strokes and their number and size were evaluated. On late MRI, transformation of previously-detected acute ischemic lesions into chronic infarction or their reversibility were assessed.
Initially, different chronic ischemic findings were found in 64% of patients from the surgical group and in 70% from catheter group. Early MRI results: acute ischemic lesions were detected in 2 (6.7%) subjects (overall 3 lesions sized <5 mm) in the catheter group and in 17 (43.6%) subjects in surgical group. Most subjects in the surgical group showed multiple lesions (88%); 195 lesions were detected, a median 6 (IQR 8) lesions per case. Eighty-two percent of lesions were <5 mm, 12% 5-10 mm, 5% 10-30 mm, and 2% were large territorial ischemia. Only 1 case was symptomatic, the rest were silent strokes. On late MRI, 53.5% of all acute lesions were reversible. Lesions <5 mm were reversible in 63.1% of cases, lesions 5-10 mm were reversible in 21.7% and all lesions larger than 10 mm persisted. In 29.4% of patients all acute ischemic lesions were fully reversible.
Periprocedural silent strokes were significantly more common after thoracoscopic epicardial ablation compared to catheter ablation considering both the number of affected patients and number of lesions. The majority of acute ischemic brain lesions were small, up to 5 mm in diameter, roughly half of which were reversible. Reversibility of acute ischemic lesions decreased with size. However, in 29.4% of affected patients, all lesions were fully reversible.
心房颤动（AF）的侵入性治疗因围手术期脑栓塞而有发生缺血性卒中的风险，这种栓塞可能是显性的或隐匿性的。我们研究的主要目的是比较经皮导管消融和胸腔镜心外膜消融治疗AF后隐匿性卒中的发生率。次要目的是评估隐匿性卒中随时间的发展情况。
我们纳入了39例接受胸腔镜消融治疗持续性症状性AF的受试者（年龄64.1±8.9岁）和30例接受导管消融治疗阵发性或持续性症状性AF的受试者（年龄64.1±10.5岁）。受试者在消融前和消融后早期接受脑部MRI检查，此外，手术组在治疗后6个月接受晚期MRI检查。在早期MRI上，评估隐匿性卒中的存在及其数量和大小。在晚期MRI上，评估先前检测到的急性缺血性病变向慢性梗死的转变或其可逆性。
最初，手术组64%的患者和导管组70%的患者发现了不同的慢性缺血性表现。早期MRI结果：导管组2例（6.7%）受试者检测到急性缺血性病变（共3个病变，大小<5 mm），手术组17例（43.6%）受试者检测到急性缺血性病变。手术组大多数受试者表现为多发性病变（88%）；共检测到195个病变，每例中位数为6个（四分位间距8）。82%的病变<5 mm，12%为5 - 10 mm，5%为10 - 30 mm，2%为大面积区域性缺血。只有1例有症状，其余均为隐匿性卒中。在晚期MRI上，所有急性病变的53.5%是可逆的。<5 mm的病变63.1%是可逆的，5 - 10 mm的病变21.7%是可逆的，所有大于10 mm的病变持续存在。29.4%的患者所有急性缺血性病变完全可逆。
考虑到受影响患者的数量和病变数量，胸腔镜心外膜消融术后围手术期隐匿性卒中比导管消融术后明显更常见。大多数急性缺血性脑病变较小，直径达5 mm，其中约一半是可逆的。急性缺血性病变的可逆性随大小而降低。然而，29.4%的受影响患者所有病变完全可逆。
