Coincidental Impact of Transcatheter Patent Foramen Ovale Closure on Migraine with and without Aura - A Comprehensive Meta-Analysis.
Coincidental Impact of Transcatheter Patent Foramen Ovale Closure on Migraine with and without Aura - A Comprehensive Meta-Analysis.
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经导管专利有孔虫封闭对偏头痛的巧合影响有或没有光环 - 一项全面的荟萃分析。
DOI：
10.1016/j.ctrsc.2016.01.002
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发表时间：
2016-03-01
期刊：
影响因子：
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通讯作者：
Asirvatham SJ
中科院分区：
文献类型：
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作者：
Kanwar SM;Noheria A;DeSimone CV;Rabinstein AA;Asirvatham SJ
我们分析了文献，以评估经导管卵圆孔未闭（PFO）封堵术对偏头痛的偶然影响，以预防卒中的二级发生。我们检索了Medline、EMBASE和科克伦数据库中截至2013年8月发表的研究。我们纳入了英语研究，这些研究提供了PFO关闭后偏头痛完全消退或改善的信息。两位研究作者确定了375篇原创文章，并独立审查了32篇相关手稿。从所有符合条件的研究中手动提取数据，包括研究方法、纳入标准、PFO闭合和偏头痛结局。采用随机效应模型计算偏头痛缓解或改善的合并比值（和概率）。分析了20项研究。大多数是非对照研究，包括少数接受PFO封堵术的隐源性卒中患者，随访时间不同。PFO封堵术（18项研究，917例患者）完全缓解偏头痛的概率为0.46（95%置信区间0.39，0.53），偏头痛（17项研究，881例患者）改善的概率为0.78（0.74，0.82）。在报告偏头痛改善的研究中有发表偏倚的证据（Begg's p=0.002），但在报告偏头痛完全缓解的研究中没有发表偏倚的证据（p=0.3）。在有先兆的患者中，PFO封堵术后偏头痛完全缓解的概率为0.54（0.43，0.65），在无先兆的患者中，完全缓解的概率为0.39（0.29，0.51）。在接受经导管PFO封堵术的不明原因卒中和偏头痛患者中，大多数有先兆的患者头痛消退，而无先兆的患者头痛消退的比例较小。
We analyzed the literature to assess the coincidental impact on migraines of transcatheter patent foramen ovale (PFO) closure performed for secondary stroke prevention. We searched Medline, EMBASE, and the Cochrane database for studies published up until August 2013. We included English-language studies that provided information on complete resolution or improvement in migraine headaches following PFO closure. Two study authors identified 375 original articles and both independently reviewed 32 relevant manuscripts. Data including study methodology, inclusion criteria, PFO closure and migraine outcomes were extracted manually from all eligible studies. Pooled odds (and probability) of resolution or improvement of migraine headaches were calculated using random-effects models. Twenty studies were analyzed. Most were uncontrolled studies that included a small number of patients with cryptogenic stroke who had undergone PFO closure and had variable time of followup. The probability of complete resolution of migraine with PFO closure (18 studies, 917 patients) was 0.46 (95% confidence interval 0.39, 0.53) and of any improvement in migraine (17 studies, 881 patients) was 0.78 (0.74, 0.82). There was evidence for publication bias in studies reporting on improvement in migraines (Begg’s p=0.002), but not for studies on complete resolution of migraine (p=0.3). In patients with aura, the probability of complete resolution of migraine post-PFO closure was 0.54 (0.43, 0.65), and in those without aura, complete resolution occurred in 0.39 (0.29, 0.51). Among patients with unexplained stroke and migraine undergoing transcatheter PFO closure, resolution of headaches occurred in a majority of patients with aura and for a smaller proportion of patients without aura.