НЕФАРМАКОЛОГИЧЕСКИЕ МЕТОДЫ В ПРОФИЛАКТИКЕ ИНСУЛЬТОВ У ПАЦИЕНТОВ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ: ОТ ИНТЕРВЕНЦИОННЫХ ПОДХОДОВ К ХИРУРГИИ

Основные положения

• Профилактика развития ишемического инсульта при фибрилляции предсердий является важной задачей здравоохранения. Фармакологические стратегии профилактики тромбоэмболических событий имеют ряд ограничений и противопоказаний. В связи с этим стали разрабатываться инвазивные методы, направленные на изоляцию ушка левого предсердия, как основного источника тромбообразования у больных неклапанной формой фибрилляции предсердий. Цель нашего обзора заключалась в предоставлении комплексной информации эффективности и безопасности интервенционных и хирургических подходов изоляции ушка левого предсердия.

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.

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