冠状动脉旁路移植术后卒中及其与颈-颅动脉病变相关性的研究进展

Progress in stroke after coronary artery bypass grafting and its association with carotidcerebral artery disease

冠状动脉旁路移植术(coronary artery bypass grafting,CABG)是左主干及复杂多支冠状动脉病变血运重建治疗的“金标准”。CABG术后卒中是一种相对少见但具有灾难性后果的并发症,并造成严重的卫生经济负担。近年来,对“泛血管疾病”这一概念的深入理解、“心脑一体化”诊疗理念的推行以及相关诊疗技术的提高,为该并发症的防治提供了新的选择。本文聚焦于颈-颅动脉病变这一关键因素,系统回顾了CABG术后卒中的发病率、流行病学现状、危险因素、发生机制及防治要点,分析了术后卒中与颈-颅动脉病变的关联,总结了预防性颈-颅动脉血运重建策略的循证依据,并对未来的研究方向做出展望。

Coronary artery bypass grafting(CABG)is the"gold standard"for revascularization of left main diseased and/or complex multi-vessel diseased coronary artery disease.Post-CABG stroke is a relatively rare but catastrophic complication with a serious health and economic burden.In recent years,the further understanding of the concept of"panvascular disease",the implementation of the philosophy of"cardio-cerebral integrated treatment",and the improvement of related diagnostic and therapeutic techniques have provided new options for the recognition,prevention and cure of post-CABG stroke.Focusing on the key factor of carotid-cerebral artery disease,this review systematically scrutinizes the incidence,epidemiology,risk factors,mechanisms and prevention and treatment of post-CABG stroke.This review analyzes the association between post-CABG stroke and carotid-cerebral artery disease,summarizes the status of evidence-based prophylactic carotid-cerebral artery revascularization strategy,and prospects for future research directions.