既往颅内出血患者左心耳关闭的安全性、有效性和时机

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia Pub Date : 2025-09-01 DOI:10.1016/j.nrl.2023.11.012

D. Gonzalez-Calle , L. Nombela-Franco , H. Gutierrez-Garcia , V. Peral , J. Mesnier , G. Tirado-Conde , A. Barrero-Mier , A. Morcuende Gonzalez , G. O’Hara , L. López-Mesonero , P. Salinas , L. Sanchís , P. Cepas-Guillén , A. Laffond , X. Freixa , I. Amat-Santos , P.L. Sanchez , J. Rodes-Cabau , I. Cruz-Gonzalez

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引用次数: 0

摘要

背景：在房颤（AF）和CHA2DS2-VASc≥2的患者中，经口抗凝（OAC）使用增加颅内出血（ICH）的风险。左心耳闭塞术（LAAO）是OAC的一种替代方法，但关于其在既往脑出血患者中的应用的数据很少，其表现的时机也存在争议。此外，这组患者的长期预后以前没有描述过。目的评价LAAO治疗非瓣膜性房颤合并既往脑出血（CHA2DS2-VASc≥2）患者的安全性和有效性，并确定其应用时机。方法：这是一个多中心回顾性登记，包括128例患者，该手术的适应症为脑出血。患者分为两组：早期闭塞（n = 31, 24.2%），在出血后90天前进行手术；晚期闭塞（n = 97, 75.8%），在90天后进行手术。结果全组手术成功率97%（124/128）。4例（3.15%）发生手术相关并发症：2例心包填塞，1例器械栓塞，1例住院期间短暂性脑缺血发作。在平均随访73.9±34.1个月后，与基于CHA2DS2-VASc和HASBLED评分的预期相比，缺血率和出血率显著降低（分别为93.9%和89.9%）。早期和晚期闭塞组的基线特征、手术成功率和并发症发生率均无显著差异。此外，早期和晚期闭塞组在死亡率、缺血性事件或出血方面没有统计学上的显著差异。结论左心耳闭塞术是一种有效、安全的治疗方案，可降低房颤合并颅内出血患者发生缺血性脑卒中的风险。在本研究中，我们没有发现早期闭合与晚期闭合在安全性和有效性方面存在差异。需要进一步的研究来支持早期关闭以减少口服抗凝停药相关的并发症。

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Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing

Background

Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHA₂DS₂-VASc ≥ 2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described previously.

Objective

To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHA₂DS₂-VASc ≥ 2) and to determine adequate timing of its performance.

Methods

This is a multicenter retrospective registry that included 128 patients, whose indication for this procedure was ICH. Patients were divided into two groups: early occlusion (n = 31; 24.2%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (n = 97; 75.8%), after 90 days.

Results

Global procedural success was of 97% (124/128). Procedure-related complications occurred in 4 patients (3.15%): 2 cardiac tamponade, 1 device embolization and 1 transient ischemic attack during hospitalization. There was a significant reduction in the ischemic and bleeding rates compared to expected based on CHA₂DS₂-VASc and HASBLED scores (93.9% and 89.9% respectively) after a mean follow-up of 73.9 ± 34.1 months. There were no significant differences neither in baseline characteristics between the early and late occlusion groups nor in the procedural success or complications rates. Furthermore, no statistically significant differences were found in mortality, ischemic events, or hemorrhage between the early and late occlusion group.

Conclusions

Left atrial appendage occlusion is an effective and safe treatment alternative to reduce the risk of ischemic stroke in selected patients with atrial fibrillation and prior intracranial hemorrhage. In this study, we did not find differences regarding safety and efficacy in early closure compared with late closure. Further studies are needed to support early closure to reduce the complications associated with oral anticoagulation withdrawal.

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来源期刊

Neurologia 医学-临床神经学

CiteScore

5.90

自引率

2.60%

发文量

135

审稿时长

48 days

期刊介绍： Neurología es la revista oficial de la Sociedad Española de Neurología y publica, desde 1986 contribuciones científicas en el campo de la neurología clínica y experimental. Los contenidos de Neurología abarcan desde la neuroepidemiología, la clínica neurológica, la gestión y asistencia neurológica y la terapéutica, a la investigación básica en neurociencias aplicada a la neurología. Las áreas temáticas de la revistas incluyen la neurologia infantil, la neuropsicología, la neurorehabilitación y la neurogeriatría. Los artículos publicados en Neurología siguen un proceso de revisión por doble ciego a fin de que los trabajos sean seleccionados atendiendo a su calidad, originalidad e interés y así estén sometidos a un proceso de mejora. El formato de artículos incluye Editoriales, Originales, Revisiones y Cartas al Editor, Neurología es el vehículo de información científica de reconocida calidad en profesionales interesados en la neurología que utilizan el español, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo.