Профилактика периоперационного ишемического инсульта после некардиохирургических и ненейрохирургических операций в свете Научного заявления и Рекомендаций по вторичной профилактике ишемического инсульта и транзиторной ишемической атаки AHA/ASA. Часть 2: периоперационная антитромботическая терапия, диагностика, лечение

Одной из возможных мер, способных улучшить качество оказания медицинской помощи, уменьшить число неблагоприятных исходов, а также достичь целевых значений по применению реперфузионных методов лечения при остром ишемическом инсульте, является совершенствование системы оказания помощи пациентам с внутригоспитальным ишемическим инсультом. Одним из видов внутригоспитального инсульта является периоперационный инсульт – инсульт, развившийся во время или спустя 30 дней после выполнения хирургической операции. С момента опубликования в 2014 г. последней фундаментальной работы на тему профилактики периоперационного инсульта подходы к первичной и вторичной профилактике, диагностике, консервативному и реперфузионному лечению ишемического инсульта были серьёзно модифицированы. Произошедшие многочисленные изменения создали предпосылки к пересмотру существующих подходов к оказанию помощи при периоперационном ишемическом инсульте. В 2021 г. в свет вышли обновлённые документы зарубежных исследователей/ассоциаций, посвящённые проблеме периоперационного ишемического инсульта у пациентов некардиохирургического и ненейрохирургического профиля. Во второй части обзора представлены современные данные, посвящённые вопросам периоперационной антитромботической профилактики, клинической и инструментальной диагностики, лечения и организации оказания помощи при периоперационном ишемическом инсульте у данной категории пациентов. Подробнорассмотрены вопросы применения у пациентов некардиохирургического и ненейрохирургического профиля с периоперационным инсультом реперфузионных методов лечения – системной тромболитической терапии и эндоваскулярных вмешательств, в т. ч. приведён мировой опыт их применения «off-label».

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