kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2025-14-4-102-122kpccz-1697Research ArticleАНАЛИТИЧЕСКИЙ ОБЗОР. Сердечно-сосудистая хирургия. АритмологияНЕФАРМАКОЛОГИЧЕСКИЕ МЕТОДЫ В ПРОФИЛАКТИКЕ ИНСУЛЬТОВ У ПАЦИЕНТОВ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ: ОТ ИНТЕРВЕНЦИОННЫХ ПОДХОДОВ К ХИРУРГИИNON-PHARMACOLOGICAL METHODS IN STROKE MANAGEMENT IN PATIENTS WITH ATRIAL FIBRILLATION: FROM INTERVENTIONAL METHODS TO SURGERYhttps://orcid.org/0000-0001-5837-7255СтребковаЕлизавета ДмитриевнаStrebkovaElizaveta D.

кандидат медицинских наук научный сотрудник аритмологического отдела федерального государственного бюджетного учреждения «Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация

PhD, Researcher at the Department of Arrhythmological Department, Federal State Budgetary Educational Institution “A.V. Vishnevskiy National Medical Research Center of Surgery” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation

elizabeth.strebkova@yandex.ruhttps://orcid.org/0000-0001-7065-0250АртюхинаЕлена АлександровнаArtyukhinaElena A.

доктор медицинских наук, профессор руководитель отделения электрофизиологических рентгенэндоваскулярных методов диагностики и лечения аритмий федерального государственного бюджетного учреждения «Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация; профессор кафедры ангиологии, сердечно-сосудистой, эндоваскулярной хирургии и аритмологии имени академика А.В. Покровского федерального государственного бюджетного образовательного учреждения дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация

PhD, Professor, Head of the Department of Electrophysiological and Endovascular Image-guided Methods of Diagnosis and Treatment of Arrhythmias, Federal State Budgetary Educational Institution “A.V. Vishnevskiy National Medical Research Center of Surgery” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation; Professor at the Department of Angiology, Cardiovascular, Endovascular Surgery and Arrhythmology named after Academician A.V. Pokrovsky, Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation

artelena.71@mail.ruhttps://orcid.org/0000-0001-8231-6866КадыроваМадинаKadirovaMadina

кандидат медицинских наук заведующая отделением ультразвуковой диагностики федерального государственного бюджетного учреждения «Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация

PhD, Head of the ultrasound department Federal State Budgetary Educational Institution “A.V. Vishnevskiy National Medical Research Center of Surgery” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation

kadirova@list.ruhttps://orcid.org/0000-0003-1791-9163РевишвилиАмиран ШотаевичRevishviliAmiran S.

академик РАН, доктор медицинских наук, профессор директор федерального государственного бюджетного учреждения «Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация; заведующий кафедрой ангиологии, сердечно-сосудистой, эндоваскулярной хирургии и аритмологии имени академика А.В. Покровского федерального государственного бюджетного образовательного учреждения дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация

Academician of the Russian Academy of Sciences, PhD, Professor, Director of the Federal State Budgetary Educational Institution “A.V. Vishnevskiy National Medical Research Center of Surgery” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation; Head of the Department of Angiology, Cardiovascular, Endovascular Surgery and Arrhythmology named after Academician A.V. Pokrovsky, Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation

amirevi@mail.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution “A.V. Vishnevskiy National Medical Research Center of Surgery” of the Ministry of Healthcare of the Russian FederationRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное образовательное учреждение дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution “A.V. Vishnevskiy National Medical Research Center of Surgery” of the Ministry of Healthcare of the Russian Federation; Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federa-tionRussian Federation202531082025144102122Copyright © Стребкова Е.Д., Артюхина Е.А., Кадырова М., Ревишвили А.Ш., 20252025Стребкова Е.Д., Артюхина Е.А., Кадырова М., Ревишвили А.Ш.Strebkova E.D., Artyukhina E.A., Kadirova M., Revishvili A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/1697Основные положения

Основные положения

 

 

Резюме

Резюме

Фибрилляция предсердий (ФП) ассоциирована с высоким риском развития системных тромбоэмболических (ТЭ) событий. Профилактика развития ишемического инсульта при ФП является важной задачей и зависит от первичного скрининга, адекватной и своевременной оценки риска развития инсульта у больного. Начиная с 2010 года новые прямые пероральные антикоагулятны (ОАК) стали ведущим методом фармакотерапии для профилактики инсультов у пациентов с ФП. Среднесрочная приверженность к приему препаратов ОАК остается крайне низкой, лишь 60% продолжают прием антикоагулятнов через 1,3 лет после диагностированной ФП. Кроме того, существуют пациенты, у которых несмотря на регулярный прием ОАК, сохраняется высокая частота ТЭ событий. Эти данные, а также информация о том, что при изолированной ФП примерно до 90% тромбов локализуется в ушке левого предсердия (УЛП), послужили основанием для разработки, тестирования и последующего клинического внедрения инвазивных стратегий изоляции УЛП из системного кровотока. Таким образом, среди методов изоляции УЛП выделяют: (1) открытые хирургические; (2) эндоваскулярные; (3) минимальноинвазивные видеоассистированные. Основной целью данного литературного обзора является представление последних данных по эффективности и безопасности основных стратегий профилактики развития тромбоэмболических событий у пациентов с ФП.

Highlights

Highlights

 

 

Abstract

Abstract

Atrial fibrillation (AF) is associated with a high risk of systemic thromboembolic (TE) events. Prevention of ischaemic stroke development in AF is an important task and depends on primary screening, adequate and timely assessment of the patient's risk of stroke development. Medium-term adherence to NOAC medication remains very low, with only 60% continuing anticoagulants 1.3 years after AF diagnosis. In addition, there are patients who continue to have a high incidence of TE events despite regular administration of NOACs. These results, together with the information that in isolated AF, approximately 90% of thrombi are localised in the left atrial appendage (LAA), have prompted the development, testing and subsequent clinical implementation of invasive strategies to isolate the LAA from the systemic blood flow. Thus, among the methods of isolation of LAA are (1) open surgical; (2) endovascular; and (3) minimally invasive video-assisted. The main purpose of this literature review is to present the latest evidence on the efficacy and safety of the main strategies for the prevention of thromboembolic events in patients with AF.

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