Геморрагическая трансформация ишемического инсульта

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.

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