提高心源性卒中的诊治水平:任重而道远

A call to improve the diagnosis and treatment of cardiogenic stroke: there is still a long way to go

心源性卒中占全部缺血性卒中的20%~30%,是指来自心脏和主动脉弓的栓子通过循环导致脑动脉栓塞引起相应脑功能障碍的临床综合征。在病因分类方面,心源性卒中与隐匿性卒中、不明来源栓塞性卒中的界定,主动脉弓粥样硬化的归属有待明确;在诊断方面,其标准亟须制订统一,对此笔者提出了新的诊断标准;在治疗方面,笔者认为应于卒中(房颤相关)发病数天至数周后启动或重启抗凝治疗,急性期和预防卒中复发的治疗应经多学科会诊后积极进行。

Cardiogenic stroke,manifested as a clinical syndrome in which emboli from the heart and aortic arch pass through the circulation and cause cerebral artery embolism and corresponding brain dysfunction,accounts for 20%to 30%of all ischemic strokes.Regarding the etiological classification,the boundary between cardiogenic stroke and cryptogenic stroke,especially embolic stroke of undetermined source(ESUS),as well as aortic arch atheromas categorization remain uncertain.Concerning the diagnosis,the criteria need to be formulated and unified,and thus the author proposes new diagnostic criteria.With regard to the treatment,anticoagulation therapy should be started or restarted several days to several weeks after the onset of stroke(e.g.,atrial fibrillation-related),and treatment during acute phase and for prevention of stroke recurrence should be initiated after multi-disciplinary consultation.