中国脑血管病杂志2026，Vol.23Issue(8)：515-526,12.DOI:10.3969/j.issn.1672-5921.2026.08.002
心脏介入围手术期并发急性缺血性卒中八例临床特征初步分析
Preliminary analysis of clinical characteristics of eight cases of perioperative acute ischemic stroke complicating cardiac intervention
摘要
Abstract
Objective To preliminarily investigate the clinical characteristics of patients with perioperative acute ischemic stroke(AIS)after cardiac intervention.Methods Patients with perioperative AIS(time of onset＜24 h)associated with cardiac intervention that were admitted to the Department of Neurology and Department of Cardiology at the First Hospital of Changsha(Changsha Hospital Affiliated to Xiangya School of Medicine,Central South University)from January 2024 to December 2025.General data,details of the cardiac intervention-related index,and AIS-related data were collected.General data included sex,age,hypertension,type 2 diabetes mellitus,smoking,alcohol consumption,previous cardiac disease types(stable angina,unstable angina,prior coronary stenting,atrial fibrillation),previous regular antithrombotic therapy,previous regular statin therapy,dyslipidemia(low-density lipoprotein cholesterol ≥1.80mmol/L),and presence of carotid unstable plaque.Data on the cardiac intervention-related index included cardiac disease type(acute coronary syndrome[ST-segment elevation myocardial infarction,non-ST-segment elevation myocardial infarction,unstable angina],atrial fibrillation),preoperative antithrombotic regimen,timing of intervention(emergency,elective),procedure type(drug-eluting stent implantation,balloon angioplasty,thrombus aspiration,stent thrombectomy,and radiofrequency ablation for atrial fibrillation),puncture site(right radial artery,right femoral vein),target vessels,and intraoperative blood pressure and heart rate changes.AIS-related data included timing of stroke onset(intraprocedural,post-procedure),clinical symptoms,baseline National Institutes of Health stroke scale(NIHSS)score(mild neurological deficit:≤4;moderate:5-15;moderate to severe:16-20;severe:21-42),infarct location and culprit vessel,trial of Org 10172 in acute stroke treatment(TOAST)classification;the endovascular treatment-related data are collected including onset-to-puncture time,onset-to-recanalization time,endovascular procedure type,intraprocedural antithrombotic agents(unfractionated heparin,unfractionated+tirofiban),immediate post-procedural modified thrombolysis in cerebral infarction(mTICI)grade,thrombus appearance and antithrombotic regimen post-stroke or post-endovascular treatment,complications within 1 week post-stroke.Neurological function was assessed at 90 and 180 days post-stroke via outpatient visit or telephone interview using the modified Rankin scale(mRS),with mRS score 0-2 defined as favorable and mRS score ≥3 as unfavorable.Results A total of 8 patients with perioperative AIS complicating cardiac intervention were enrolled,including 3 males and 5 females,aged 48-86years,with a median age of 71(57,82)years.AIS occurred during the cardiac intervention in 4 patients and 4-20 h after the procedure in the remaining 4 patients.The NIHSS score at stroke onset ranged from 1 to 32,with a median of 19(7,20);neurological deficits were mild in 1 patient,moderate in 2,moderate to severe in 4,and severe in 1.Among the 8 patients with AIS,TOAST classification showed cardioembolism in 2 patients,small-artery occlusion in 2,large-artery atherosclerosis in 1,other determined etiology(procedure-related embolism)in 2,and undetermined etiology in 1.Two patients with small-artery occlusion received medical therapy alone,whereas the remaining 6 patients underwent emergency endovascular treatment,all achieving immediate post-procedural mTICI grade 3.At 90-and 180-day follow-up,favorable outcomes were observed in 3 patients,and unfavorable outcomes in 5,including 2 deaths,both of which were due to severe multiple organ failure caused by concurrent cardio-cerebral infarction.Conclusions Perioperative AIS complicating cardiac intervention presents with varying degrees of neurological deficits and distinct clinical characteristics.Embolism is the predominant etiology,but the underlying mechanisms are highly individualized;therefore,therapeutic decision-making should also be individualized.关键词
经皮冠状动脉介入治疗/围手术期并发症/急性缺血性卒中/心脑共病Key words
Percutaneous coronary intervention/Perioperative complication/Acute ischemic stroke/Cardio-cerebral comorbidity引用本文复制引用
肖利君,陈婵娟,张创,万奇,刘媛,欧阳松,李苗..心脏介入围手术期并发急性缺血性卒中八例临床特征初步分析[J].中国脑血管病杂志,2026,23(8):515-526,12.基金项目
2025年度湖南省自然科学基金项目(2025JJ80474) （2025JJ80474）
