Геморрагическая трансформация ишемического инсульта
https://doi.org/10.18705/1607-419X-2021-27-1-41-50
Аннотация
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.
Ключевые слова
Об авторах
М. Г. ПетровРоссия
Петров Михаил Григорьевич — невролог.
Санкт-Петербург
С. С. Кучеренко
Россия
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
М. П. Топузова
Россия
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
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Для цитирования:
Петров М.Г., Кучеренко С.С., Топузова М.П. Геморрагическая трансформация ишемического инсульта. Артериальная гипертензия. 2021;27(1):41-50. https://doi.org/10.18705/1607-419X-2021-27-1-41-50
For citation:
Petrov M.G., Kucherenko S.S., Topuzova M.P. Hemorrhagic transformation of ischemic stroke. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2021;27(1):41-50. (In Russ.) https://doi.org/10.18705/1607-419X-2021-27-1-41-50