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Клиническая значимость скрытых инсультов при операциях на сонных артериях: систематический обзор и метаанализ

Клиническая значимость скрытых инсультов при операциях на сонных артериях: систематический обзор и метаанализ

Авторы:
Леван Бондоевич Берикашвили,
Анастасия Владимировна Смирнова,
Павел Викторович Рыжков,
Кристина Кирилловна Каданцева,
Михаил Яковлевич Ядгаров,
Алексей Александрович Яковлев,
Валерий Владимирович Лихванцев

Журнал: Анестезиология и реаниматология. 2026;(5):72-80.

DOI: 10.17116/anaesthesiology202605172

Прочитано: 89 раз

Резюме

Периоперационные скрытые инсульты (silent brain infarcts — SBI) — частое явление при вмешательствах на сонных артериях, выявляемое только при магнитно-резонансной томографии. Клиническая значимость SBI малоизучена, а имеющиеся данные противоречивы.

ЦЕЛЬ ИССЛЕДОВАНИЯ

Оценить клинические последствия периоперационных скрытых инсультов у пациентов, перенесших вмешательство на сонных артериях.

МАТЕРИАЛ И МЕТОДЫ

Выполнен метаанализ в соответствии с рекомендациями PRISMA и руководством Кокрановского сообщества. Поиск проведен в базах данных PubMed и Cochrane Library с последующим использованием методов прямого и обратного «снежного кома». Конечными точками исследования были частота очагового неврологического дефицита, послеоперационной когнитивной дисфункции и летального исхода у пациентов с выявленным скрытым инсультом (группа SBI+) и без него (группа SBI–) после вмешательств на сонной артерии. Оценка риска систематических ошибок проведена с использованием инструмента CLARITY.

РЕЗУЛЬТАТЫ

В исследование включены 8065 пациентов, из них у 2077 (25,8%) выявлен периоперационный SBI. Статистически значимые различия в исходах между группами SBI+ и SBI– не обнаружены. Оценка риска систематических ошибок выявила низкое качество большинства включенных в метаанализ исследований.

ЗАКЛЮЧЕНИЕ

Несмотря на отсутствие статистически значимой связи между скрытыми инсультами и неблагоприятными исходами, интерпретацию результатов следует осуществлять осторожно. Перспективы исследований включают оценку долгосрочных последствий и клинической значимости выявленных изменений.

Ключевые слова

  • инфаркт головного мозга
  • магнитно-резонансная томография
  • когнитивная дисфункция
  • нейровизуализация
  • каротидная эндартерэктомия
  • стеноз сонных артерий

Конфликт интересов

Авторы заявляют об отсутствии конфликта интересов.

Дата поступления: 16.01.2026

Дата принятия в печать: 05.03.2026

Дата публикации: 15.10.2026

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