Perioperative stroke
Perioperative stroke
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DOI：
10.1586/14737175.7.8.1003
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发表时间：
2007-08
影响因子：
4.3
通讯作者：
Uma Menon;M. Kenner;Roger E Kelley
中科院分区：
文献类型：
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作者：
Uma Menon;M. Kenner;Roger E Kelley
越来越多的人认识到，可以识别围手术期卒中的高风险患者。在手术期间发生卒中的风险相当大，并且人们认识到，最初存在血管事件风险的患者最有可能因侵入性手术而增加这种风险。高风险患者包括高龄患者，随着时间的推移，高血压、动脉粥样硬化、糖尿病、心脏病和凝血障碍并存的风险会累积。存在许多与该过程相关联的可能机制（例如，术前高凝状态、手术时保持抗血栓治疗和心律失常），可能会促进血栓栓塞事件。这方面的例子包括：与头部和颈部手术相关的颅外血管的直接机械创伤;以及由于影响脑循环的血管和创新血管内手术导致的血管损伤（例如，颈动脉内膜切除术、具有支架的颅外或颅内血管成形术以及使用MERCI®凝块回收装置），以及已经开发的用于闭塞脑动脉瘤和动静脉畸形的各种血管内方法，其分别作为手术夹闭和手术切除的替代。
It is increasingly recognized that one can identify a higher risk patient for perioperative stroke. The risk of stroke around the time of operative procedures is fairly substantial and it is recognized that patients initially at risk for vascular events are those most likely to have this risk heightened by invasive procedures. Higher risk patients include those of advanced age and there is a cumulative risk, over time, of coexistent hypertension, atherosclerosis, diabetes mellitus, cardiac disease and clotting disorders. There are a number of possible mechanisms associated with the procedure (e.g., preoperative hypercoagulability, holding of antithrombic therapy at the time of the procedure and cardiac arrhythmia) that can promote a thrombo–embolic event. Examples of these include: direct mechanical trauma to extracranial vessels related to operations on the head and neck; and vascular injury as a consequence of vascular and innovative endovascular procedures affecting the cerebral circulation (e.g., carotid endarterectomy, extracranial or intracranial angioplasty with stenting, and use of the MERCI® clot retrieval device), as well as various endovascular methods that have been developed to obliterate cerebral aneurysms and arteriovenous malformations as an alternative to surgical clipping and surgical resection, respectively.