癌症相关性缺血性卒中:病理生理学、临床特征和治疗

Cancer-associated ischemic stroke:pathophysiology,clinical characteristics,and treatment

癌症可直接或通过癌症相关性高凝状态介导缺血性卒中发病。癌症相关性缺血性卒中(cancer-associated ischemic stroke, CAIS)的临床表现根据潜在病因而具有很大的异质性。一般而言,CAIS在影像学上表现为多血管供血区缺血病灶,血D-二聚体等纤维蛋白原降解产物显著升高。CAIS的治疗颇为棘手。鉴于出血风险并不高于一般人群,癌症并非静脉溶栓和机械取栓的禁忌证。CAIS的抗凝治疗应个体化考虑获益及风险,低分子肝素仍为首选,新型口服抗凝药前景良好。文章对CAIS的发病机制、临床特征及治疗进展进行了综述。

Cancer can mediate the onset of ischemic stroke directly or through cancer-associated hypercoagulability.The clinical manifestations of cancer-associated ischemic stroke(CAIS)are very heterogeneous according to the underlying cause.Generally speaking,CAIS is manifested as multiple vascular territory ischemic lesions on imaging,and fibrinogen degradation products such as blood D-dimer are significantly increased.The treatment of CAIS is quite tricky.Given that the risk of bleeding is not higher than that of the general population,cancer is not a contraindication for intravenous thrombolysis and mechanical thrombectomy.Anticoagulant therapy of CAIS should be individualized according to the benefits and risks.Low molecular weight heparin is still the first choice,and new oral anticoagulants have good prospects.This article reviews the pathogenesis,clinical features and treatment progress of CAIS.