心房颤动合并与脑淀粉样血管病相关的脑出血患者的左心耳封堵术：一项多中心观察性研究及已发表研究的汇总分析
Left atrial appendage occlusion in patients with atrial fibrillation and intracerebral haemorrhage associated with cerebral amyloid angiopathy: a multicentre observational study and pooled analysis of published studies.
作者信息
Thiankhaw Kitti, Best Jonathan, Srivastava Sonal, Prachee Ishika, Agarwal Smriti, Tan Serena, Calvert Patrick A, Chughtai Asim, Ang Richard, Segal Oliver R, Werring David J
机构信息
Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand.
出版信息
J Neurol Neurosurg Psychiatry. 2025 May 14;96(6):528-536. doi: 10.1136/jnnp-2024-334718.
BACKGROUND
Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial appendage occlusion (LAAO) is a method for ischaemic stroke prevention in patients with atrial fibrillation (AF), potentially reducing the risk of intracranial bleeding in CAA-associated ICH. We aimed to determine the outcomes of patients with AF with CAA-associated ICH undergoing LAAO.
METHODS
We conducted a multicentre study of patients with CAA-associated ICH who underwent LAAO for stroke prevention. We pooled our findings with data from a systematic review of relevant published studies of LAAO for AF in ICH survivors reporting CAA diagnosis.
RESULTS
We included data from two published studies (n=65) with CAA-specific data and our cohort study (n=37), providing a total of 102 participants (mean age 76.2±8.0 years, 74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The median follow-up period was 9.4 months (IQR 4.2-20.6). Postprocedural antithrombotic regimens varied between single (73.0%) or dual antiplatelet therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a median duration of 42 days (IQR 35-74). Postprocedural complications were uncommon, but included transient arrhythmias (2.1%) and non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73 (95% CI 0.41 to 13.94) per 100 patient years, respectively.
CONCLUSIONS
LAAO followed by short-term antithrombotic therapy might be a safe and effective ischaemic stroke preventive strategy in people with CAA-associated ICH and AF. However, randomised controlled trials are needed to determine how LAAO compares with long-term DOAC in this population.
PROSPERO REGISTRATION NUMBER
CRD42023415354.
背景
脑淀粉样血管病（CAA）是脑出血（ICH）的常见病因，复发风险高。左心耳封堵术（LAAO）是预防心房颤动（AF）患者缺血性卒中的一种方法，可能降低CAA相关ICH患者的颅内出血风险。我们旨在确定接受LAAO的CAA相关ICH合并AF患者的预后。
方法
我们对因预防卒中而接受LAAO的CAA相关ICH患者进行了一项多中心研究。我们将研究结果与对已发表的关于ICH幸存者中LAAO用于AF且报告CAA诊断的相关研究的系统评价数据进行汇总。
结果
我们纳入了两项已发表研究（n = 65）的CAA特异性数据以及我们的队列研究（n = 37）的数据，共有102名参与者（平均年龄76.2±8.0岁，74.6%为男性）患有CAA相关症状性ICH且AF接受了LAAO治疗。中位随访期为9.4个月（四分位间距4.2 - 20.6）。术后抗栓方案包括单一抗血小板治疗（73.0%）、双联抗血小板治疗（16.2%）或直接口服抗凝剂（DOAC）（10.8%），中位持续时间为42天（四分位间距35 - 74）。术后并发症不常见，但包括短暂性心律失常（2.1%）和非危及生命的心包填塞（2.1%）。随访期间缺血性卒中和ICH的合并发生率分别为每100患者年5.16（95%置信区间1.36至17.48）和2.73（95%置信区间0.41至13.94）。
结论
LAAO联合短期抗栓治疗可能是CAA相关ICH合并AF患者安全有效的缺血性卒中预防策略。然而，需要随机对照试验来确定LAAO与该人群长期DOAC治疗相比的效果。
PROSPERO注册号：CRD42023415354。
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