单纯左心耳干预预防心源性脑卒中的研究进展

Prevention of Cardiogenic Stroke by Simple Intervention of Left Atrial Appendage

心房颤动(Af)是临床上最常见的心律失常之一,其引起的血栓栓塞常见且危害极大。单纯处理Af无法完全避免血栓栓塞的发生,需针对血栓的形成进行治疗。传统预防血栓栓塞主要依靠口服抗栓药物,但口服抗栓药物多具有出血风险、用药禁忌和患者依从性差等不足,通常不能完全达到Af抗凝的预期效果。随着解剖及病理学研究的深入,现已证实血栓主要形成于Af患者的左心耳(LAA),因此可通过闭合LAA来预防血栓栓塞。内科经皮LAA封堵术因其器械相关血栓以及并发症严重等劣势而难以推广使用。传统外科手术切除LAA成功率低,风险大,并发症多,所以无法作为首选治疗方式。LAA夹闭术以其微创、手术成功率高和并发症少等优势,在预防Af患者血栓栓塞中的作用日益被关注。现就LAA夹闭术的有效性、安全性、耐久性和存在的争议等方面进行综述。

Atrial fibrillation is one of the most common arrhythmias in clinic,and thromboembolism caused by atrial fibrillation is common and harmful.The treatment of atrial fibrillation alone cannot completely avoid the occurrence of thromboembolism,so it is necessary to treat the formation of thrombus.The traditional prevention of thromboembolism mainly depends on oral antithrombotic drugs,but oral antithrombotic drugs often have shortcomings such as bleeding risk,medication contraindication and poor patient compliance,which usually can not fully achieve the expected effect of atrial fibrillation anticoagulation.With the development of anatomical and pathological research,it has been proved that thrombosis is mainly formed in the left atrial appendage(LAA)of atrial fibrillation patients.Therefore,thrombosis can be prevented by closing the LAA.Internal medicine percutaneous LAA occlusion is difficult to be popularized because of its equipment related thrombosis and serious complications.Traditional surgical resection of LAA has low success rate,high risk and many complications,so it can not be used as the first choice of treatment.LAA clipping has attracted more and more attention in the prevention of thromboembolism in atrial fibrillation patients for its advantages of minimally invasive,high success rate and less complications.This paper reviews the effectiveness,safety,durability and controversy of LAA clipping.