arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2021-27-1-41-50arthyper-1884Research ArticleСтатьиArticlesГеморрагическая трансформация ишемического инсультаHemorrhagic transformation of ischemic strokehttps://orcid.org/0000-0003-4886-7810ПетровМ. Г.PetrovM. G.

Петров Михаил Григорьевич — невролог.

Санкт-Петербург

Mikhail G. Petrov - MD, Neurologist.

St Petersburg

umkamf58@gmail.comhttps://orcid.org/0000-0001-8258-094XКучеренкоС. С.KucherenkoS. S.

Кучеренко Станислав Сергеевич — доктор медицинских наук, заведующий неврологическим отделением № 2 ФГБУ Северо-Западный ОНКЦ им. Л.Г. Соколова ФМБА, профессор кафедры неврологии и психиатрии ФГБУ НМИЦ им. B. A. Алмaзoвa» Минздрава России.

Санкт-Петербург

Stanislav S. Kucherenko - MD, PhD, DSc, Head, Neurological Department № 2, North-Western DSCC named after L.G. Sokolov Federal Medical and Biological Agency, Professor, Department of Neurology and Psychiatry, Almazov NMRC.

St Petersburg

dr.kucherenko@mail.comhttps://orcid.org/0000-0002-0175-3085ТопузоваМ. П.TopuzovaM. P.

Топузова Мария Петровна — кандидат медицинских наук, доцент кафедры неврологии и психиатрии ФГБУ «НМИЦ им. B. A. Алмaзoвa» Минздрава России.

Ул. Аккуратова, д. 2, Санкт-Петербург, 197341

Mariya P. Topuzova - MD, PhD, Senior Scientist, Associate Professor, Department of Neurology and Psychiatry.

2 Akkuratov street, St Petersburg, 197341

topuzova_mp@almazovcentre.ruГосударственное бюджетное учреждение здравоохранения Ленинградская областная клиническая больницаРоссияLeningrad Regional Clinical HospitalRussian FederationФедеральное государственное бюджетное учреждение Северо-Западный окружной научно-клинический центр им. Л. Г. Соколова Федерального медико-биологического агентства; Федеральное государственное бюджетное учреждение Национальный медицинский исследовательский центр имени B. A. Алмaзoвa Министерства здравоохранения Российской ФедерацииРоссияNorth-Western District Scientific and Clinical Center named after L.G. Sokolov; Almazov National Medical Research CentreRussian FederationФедеральное государственное бюджетное учреждение Национальный медицинский исследовательский центр имени B. A. Алмaзoвa Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian Federation2021070420212714150Copyright © Петров М.Г., Кучеренко С.С., Топузова М.П., 20212021Петров М.Г., Кучеренко С.С., Топузова М.П.Petrov M.G., Kucherenko S.S., Topuzova M.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1884

Статья посвящена проблеме геморрагической трансформации (ГТ) ишемического инсульта. Представлены частота и актуальность этого осложнения в клинической практике с учетом широкого внедрения методов церебральной реканализации: внутривенной тромболитической терапии и внутрисосудистой тромбоэмболэктомии. Рассмотрены вопросы этиологии и патогенеза ГТ. Разобраны альтернативные механизмы, лежащие в основе развития ГТ. Показано, что вероятность ГТ повышается при обширных церебральных ишемических очагах, наиболее часто ассоциированных с кардиальными источниками эмболии. Представлена роль спонтанной и медикаментозно индуцированной артериальной реканализации церебральных артерий в генезе ГТ. Отмечено, что артериальная реканализация не является обязательным условием для возникновения ГТ инфаркта мозга. Показано, что выраженность последствий ГТ определяется продолжительностью и степенью ишемии мозговой ткани. Обоснована необходимость целенаправленного поиска предикторов ГТ. Представлена классификация типов ГТ и критерии их верификации. Изучены факторы риска и шкалы, применяемые для прогнозирования ГТ. Факторы риска ГТ объединены в несколько групп: клинические, лабораторные, генетические, нейровизуализационные. Проведен их сравнительный анализ и оценена практическая значимость.

The article reviews the problem of hemorrhagic transformation (HT) of ischemic stroke. The frequency and relevance of this complication in clinical practice is high considering the widespread implementation of cerebral recanalization methods: intravenous thrombolytic therapy and intravascular thromboembolectomy. The etiology and pathogenesis, as well as alternative mechanisms underlying the development of HT are also discussed. The probability of HT increases in case of extensive cerebral ischemia commonly associated with cardiac embolism. The role of spontaneous and medication-induced arterial recanalization of cerebral arteries in the genesis HT is discussed. In particular, it is noted that arterial recanalization is not an essential factor for the occurrence of HT in cerebral infarction. The severity of HT is determined by the duration and degree of cerebral ischemia. There is a need for a targeted search for HT predictors. The classification of types and criteria of HT are presented. The risk factors and scales used to predict HT are studied. Risk factors for HT are combined into several groups: clinical, laboratory, genetic, neuroimaging. Their comparative analysis is carried out and practical significance is estimated.

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The authors declare that there are no conflicts of interest present.