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摘要

本篇出處 Acta Cardiologica Sinica 21:1 民94.03 頁1-12
篇名 New Advances in the Diagnosis and Management of Cardioembolic Stroke
作者 林美淑 ; 張念中 ; 李聰明
中文摘要   缺血性中風有1/5是源自心臟的栓塞所造成。心因性腦中風通常病況嚴重且易早期復發。核磁共振、穿顱都卜勒、心臟超音波、24小時心電圖及電氣生理學檢查可協助辨認心因性栓塞之來源。非瓣膜性心房顫動是心因性中風最常見的原因,而持續口服抗凝血劑已證實可預防中風之發生。然而臨床統計卻顯示:有心房顫動伴隨有發生心因性栓塞的危險因子且無使用抗凝血劑之禁忌者,有一半以上並沒有持續使用口服抗凝血劑。新一世代抗凝血劑似乎具有較高的安全性及使用之方便性,但是仍待大規模的臨床試驗來證實。發生急性心因性中風時,目前並不建議立即常規使用抗凝血劑治療。冠狀動脈介入治療後之中風雖然罕見,但一旦併發中風時死亡率卻很高。導管操作中完全沖刷導管、最小限度的操作導管、及使用最少量的顯影劑可減少冠狀動脈介入治療後中風之發生。
英文摘要   Cardioembolic stroke accounts for one-fifth of ischemic stroke and is severe and prone to early recurrence. Magnetic resonance imaging, transcranial Doppler, echocardiography, 24-hour electrocardiographic monitoring and electrophysiological study are tools for detecting cardioembolic sources. Non-valvular atrial fibrillation (AF) is the most common cause of cardioembolic stroke and long-term anticoagulation is proved to prevent stroke. Despite knowledge of guidelines, doctors recommend anticoagulant for less than half of patients with AF who have risk factors for cardioembolic stroke and no contraindication for its usage. Direct thrombin inhibitor offers the advantage of not needing prothrombin time controls and dose adjustments, but it needs large clinical trial for confirmation. Any type of anticoagulant by any route should not be used in acute cardioembolic stroke. Stroke after percutaneous coronary intervention (PCI), although rare, is associated with high mortality. Cardiologist must flush catheters thoroughly, minimize catheter manipulation and use minimal contrast medium during PCI.