Криптогенный инсульт. Часть 1: аорто-артериальная эмболия

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ЖурналыСоздатель/АффиляцияЭнциклопедия MeSH

Простой поискРасширенный поискИстория поисков

ГлавнаяРезультаты поиска

СтатьяМЕД СОВЕТ. 2021; № 4: 78–87. DOI:10.21518/2079-701X-2021-4-78-87

Криптогенный инсульт. Часть 1: аорто-артериальная эмболия

Кулеш А.А.^[1]

Демин Д.А.^[2]

Виноградов О.И.^[3]

^[1]Пермский государственный медицинский университет им. Е. А. Вагнера

^[2]«Федеральный центр сердечно-сосудистой хирургии» Минздрава России, Астрахань, Россия

^[3]Национальный медико-хирургический центр им. Н. И. Пирогова Минздрава РФ

В статье обсуждаются концепция эмболического инсульта из неустановленного источника и роль аорто-артериальной эмболии в его развитии. Подробно рассмотрены такие потенциальные причины эмболического криптогенного инсульта, как атероматоз аорты, нестенозирующий атеросклероз цервикальных артерий, каротидная сеть и интракраниальный атеросклероз. В рамках обсуждения каждой причины освещены вопросы эпидемиологии, патогенеза, а также современные подходы к диагностике и вторичной профилактике. Диагностический поиск представлен в виде алгоритма. Для выявления аорто-артериальных источников эмболии и определения их клинический значимости требуется развернутое обследование, включающее КТ-ангиографию с прицельной оценкой дуги аорты, чреспищеводную эхокардиографию, МРТ артериальной стенки и транскраниальную микроэмболодетекцию. При выполнении механической тромбэктомии целесообразно проводить гистологическое исследование тромбоэмбола. С учетом того что атеросклероз, как правило, имеет системный характер, поиск возможной причины аортоартериальной эмболии должен быть приоритетным направлением диагностики у пациентов с криптогенным инсультом и поражением других артерий (коронарных, нижних конечностей). В отношении вторичной профилактики криптогенного инсульта при наличии потенциальных источников аорто-артериальной эмболии применим принцип «чем эмбологеннее источник, тем агрессивнее профилактика». В арсенал вторичной профилактики входят такие стратегии, как строгий контроль сосудистых факторов риска, достижение целевого артериального давления, кратко- и среднесрочная двойная антитромбоцитарная терапия, а также интенсивная гиполипидемическая терапия. При развитии инсульта на фоне каротидной сети оправдана хирургическая профилактика, эффективность которой при нестенозирующем атеросклерозе требует скорейшей оценки в рандомизированных исследованиях. Каждая рассмотренная потенциальная причина криптогенного инсульта проиллюстрирована клиническим примером.

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Язык текста: Русский

ISSN: 2079-701X

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URI:4e432d4d4544534f5645542d41525449434c452d323032312d302d342d302d37382d3837

Унифицированный идентификатор ресурса для цитирования: //medj.rucml.ru/journal/4e432d4d4544534f5645542d41525449434c452d323032312d302d342d302d37382d3837/