r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2020-25-6-29-34r-n-j-129Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSКардиоэмболический инсульт при синдроме некомпактного миокардаCardioembolic stroke in syndrome of noncompaction cardiomyopathyhttps://orcid.org/0000-0003-1539-4068ГрачевС. П.GrachevS. P.

Москва

Moscow

grachev_s@mail.ruhttps://orcid.org/0000-0001-8159-6827БоцинаА. Ю.BotsinaA. Yu.

Москва

Moscow

a.botsina@gmail.comhttps://orcid.org/0000-0003-1733-267XЖуравлевК. Н.ZhuravlevK. N.

Москва

Moscow

kir232@mail.ruhttps://orcid.org/0000-0002-0193-2243ЗамерградМ. В.ZamergradM. V.

Москва

Moscow

zamergrad@gmail.comКафедра кардиологии ФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Минздрава России; ГКБ им И.В.ДавыдовскогоРоссияMoscow State University of Medicine and Dentistry named after A.I. Evdokimov of the Ministry of Health of Russia; State Clinical Hospital named after I.V. DavydovskyRussian FederationГКБ им И.В.ДавыдовскогоРоссияState Clinical Hospital named after I.V. DavydovskyRussian FederationГКБ им И.В.Давыдовского; Кафедра неврологии с курсом рефлексологии и мануальной терапии ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияState Clinical Hospital named after I.V. Davydovsky; Russian Medical Academy of Continuing Professional Education of the Ministry of Health of RussiaRussian Federation2020070120212562934Copyright © Грачев С.П., Боцина А.Ю., Журавлев К.Н., Замерград М.В., 20212021Грачев С.П., Боцина А.Ю., Журавлев К.Н., Замерград М.В.Grachev S.P., Botsina A.Y., Zhuravlev K.N., Zamergrad M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/129

Инсульт остается одним из самых распространенных заболеваний и причин смерти. Снижение смертности от инсульта во многом зависит от эффективности его профилактики, которая, в свою очередь, невозможна без точного представления о его причинах и механизмах развития. Представлена история болезни пациентки с ишемическим кардиоэмболическим инсультом, развившимся на фоне синдрома некомпактного миокарда — сравнительно редкого заболевания, которое может быть диагностировано при помощи доступных современных методов исследования. Алгоритм обследования пациента с подозрением на кардиоэмболический инсульт включает проведение длительного холтеровского мониторирования, эхокардиографии, КТ и МРТ сердца, что позволяет выявлять редкие причины кардиальной тромбоэмболии. Вторичная профилактика инсульта в таких случаях, вероятнее всего, должна предусматривать использование антикоагулянтов, однако исследования, уточняющие наиболее эффективные методы предотвращения повторных инсультов при редких причинах кардиальной тромбоэмболии, пока продолжаются.

Stroke remains one of the most common diseases and causes of death. Reducing mortality from stroke is in great dependence on the effectiveness of its prevention, which, in turn, is impossible without an accurate understanding of its causes and mechanisms of development. The article represents the history of a patient with ischemic cardioembolic stroke that developed against noncompaction cardiomyopathy, a relatively rare disease that can be diagnosed with the use of available modern research methods. The algorithm for examining a patient with suspected cardioembolic stroke includes long-term Holter monitoring, echocardiography, CT and MRI of the heart, which makes it possible to identify rare causes of cardiac thromboembolism. Postexposure prophylaxis of stroke in such cases is likely to include the use of anticoagulants, but studies aimed to clarify most effective methods of recurrent strokes prevention in rare causes of cardiac thromboembolism are still being conducted.

ишемический инсульткардиальная тромбоэмболиясиндром некомпактного миокардаантикоагулянтыischemic strokecardiac thromboembolismnoncompaction cardiomyopathyanticoagulantsReferencesFeigin V.L., Lawes C.M., Bennett D.A., Anderson C.S. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43–53. https://doi.org/10.1016/s1474-4422(03)00266-7Feigin V.L., Lawes C.M., Bennett D.A., Anderson C.S. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43–53. https://doi.org/10.1016/s1474-4422(03)00266-7Adams H.P.Jr., Bendixen B.H., Kapelle L.J., Biller J., Love B.B., Gordon D.L. et al. Classification of subtypes of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41. https://doi.org/10.1161/01.str.24.1.35Adams H.P.Jr., Bendixen B.H., Kapelle L.J., Biller J., Love B.B., Gordon D.L. et al. Classification of subtypes of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41. https://doi.org/10.1161/01.str.24.1.35Hart R.G., Diener H.C., Coutts S.B., Easton J.D., Granger C.B., O’Donnell M.J. et al. Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13(4):429–38. https://doi.org/10.1016/S1474-4422(13)70310-7Hart R.G., Diener H.C., Coutts S.B., Easton J.D., Granger C.B., O’Donnell M.J. et al. Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13(4):429–38. https://doi.org/10.1016/S1474-4422(13)70310-7Hart R.G., Catanese L., Perera K.S., Ntaios G., Connolly S.J. Embolic Stroke of Undetermined Source: A Systematic Review and Clinical Update. Stroke. 2017;48(4):867–872. https://doi.org/10.1161/STROKEAHA.116.016414Hart R.G., Catanese L., Perera K.S., Ntaios G., Connolly S.J. Embolic Stroke of Undetermined Source: A Systematic Review and Clinical Update. Stroke. 2017;48(4):867–872. https://doi.org/10.1161/STROKEAHA.116.016414Oechslin E., Jenni R. Left ventricular non-compaction revisited: a distinct phenotype with genetic heterogeneity? European Heart Journal. 2011;32(12), 1446–1456. https://doi.org/10.1093/eurheartj/ehq508Oechslin E., Jenni R. Left ventricular non-compaction revisited: a distinct phenotype with genetic heterogeneity? European Heart Journal. 2011;32(12), 1446–1456. https://doi.org/10.1093/eurheartj/ehq508Biasi G.M., Froio A., Diethrich E.B., Deleo G., Galimberti S., Mingazzini P. et al. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the imaging in carotid angioplasty and risk of stroke (ICAROS) study. Circulation. 2004;110(6):756–62. https://doi.org/10.1161/01.CIR.0000138103.91187.E3Biasi G.M., Froio A., Diethrich E.B., Deleo G., Galimberti S., Mingazzini P. et al. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the imaging in carotid angioplasty and risk of stroke (ICAROS) study. Circulation. 2004;110(6):756–62. https://doi.org/10.1161/01.CIR.0000138103.91187.E3Sorimachi T., Nishino K., Morita K., Takeuchi S., Ito Y., Fujii Y. Blood flow changes caused by distal filter protection and catheter aspiration in the internal carotid artery during carotid stenting: evaluation using carotid Doppler sonography. AJNR Am. J. Neuroradiol. 2011;32(2):288–93. https://doi.org/10.3174/ajnr.A2276Sorimachi T., Nishino K., Morita K., Takeuchi S., Ito Y., Fujii Y. Blood flow changes caused by distal filter protection and catheter aspiration in the internal carotid artery during carotid stenting: evaluation using carotid Doppler sonography. AJNR Am. J. Neuroradiol. 2011;32(2):288–93. https://doi.org/10.3174/ajnr.A2276Hart R.G., Sharma M., Mundl H., Kasner S.E., Bangdiwala S.I., Berkowitz S.D. et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N. Engl. J. Med. 2018;378(23):2191–2201. https://doi.org/10.1056/NEJMoa1802686Hart R.G., Sharma M., Mundl H., Kasner S.E., Bangdiwala S.I., Berkowitz S.D. et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N. Engl. J. Med. 2018;378(23):2191–2201. https://doi.org/10.1056/NEJMoa1802686Kasner S.E., Swaminathan B., Lavados P., Sharma M., Muir K., Veltkamp R. et al. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial. Lancet Neurol. 2018;17(12):1053–1060. https://doi.org/10.1016/S1474-4422(18)30319-3Kasner S.E., Swaminathan B., Lavados P., Sharma M., Muir K., Veltkamp R. et al. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial. Lancet Neurol. 2018;17(12):1053–1060. https://doi.org/10.1016/S1474-4422(18)30319-3Ntaios G., Swaminathan B., Berkowitz S.D., Gagliardi R.J., Lang W., Siegler J.E. et al. NAVIGATE ESUS Investigators. Efficacy and Safety of Rivaroxaban Versus Aspirin in Embolic Stroke of Undetermined Source and Carotid Atherosclerosis. Stroke. 2019;50(9):2477–2485. https://doi.org/10.1161/STROKEAHA.119.025168Ntaios G., Swaminathan B., Berkowitz S.D., Gagliardi R.J., Lang W., Siegler J.E. et al. NAVIGATE ESUS Investigators. Efficacy and Safety of Rivaroxaban Versus Aspirin in Embolic Stroke of Undetermined Source and Carotid Atherosclerosis. Stroke. 2019;50(9):2477–2485. https://doi.org/10.1161/STROKEAHA.119.025168Diener H.C., Sacco R.L., Easton J.D., Granger C.B., Bernstein R.A., Uchiyama S. et al. RE-SPECT ESUS Steering Committee and Investigators. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N. Engl. J. Med. 2019;380(20):1906–1917. https://doi.org/10.1056/NEJMoa1813959.Diener H.C., Sacco R.L., Easton J.D., Granger C.B., Bernstein R.A., Uchiyama S. et al. RE-SPECT ESUS Steering Committee and Investigators. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N. Engl. J. Med. 2019;380(20):1906–1917. https://doi.org/10.1056/NEJMoa1813959.

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