Recurrent stroke/TIA in cryptogenic stroke patients with patent foramen ovale
Recurrent stroke/TIA in cryptogenic stroke patients with patent foramen ovale
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DOI：
10.1017/s0317167100005825
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发表时间：
2007-02-01
影响因子：
3
通讯作者：
Jaigobin, Cheryl
中科院分区：
文献类型：
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作者：
Casaubon, Leanne;McLaughlin, Peter;Jaigobin, Cheryl
背景资料：卵圆孔未闭（PFO）存在于40%的隐源性卒中患者中，可能与脑内反常栓塞有关。治疗选择包括抗血小板药物、抗凝、经皮器械和手术闭合。我们评估了四个治疗组患者之间TIA或卒中复发率存在差异的假设。方法：前瞻性随访1997年1月至2003年6月的隐源性卒中或TIA和PFO患者。治疗选择是在个案基础上作出的。主要结局为卒中复发。次要结局是卒中、TIA和血管性死亡的复合终点。结果：基线。我们的队列包括121例患者; 64例（53%）为男性。中位年龄为43岁。69%的人出现中风，31%的人出现TIA。40%存在一种或多种血管危险因素。24%的患者存在房间隔动脉瘤（阿萨）。治疗包括抗血小板药物（34%）、抗凝（17%）、器械（39%）和手术闭合（11%）。随访16例患者发生复发事件（9例抗血小板，3例抗凝，4例器械闭合）; 7例为卒中，9例为TIA。比较单个治疗，抗血小板治疗组有卒中发生率更高的趋势（p=0.072）;复合终点存在显著差异（p=0.012）。比较闭合组与联合药物治疗组，主要（p=0.014）和次要（p=0.008）结局存在显著差异，有利于闭合。年龄和研究前事件可预测结局。结论：卵圆孔未闭闭合与较少的复发事件相关。手术和器械闭合的并发症是自限性的。
Background: Patent foramen ovale (PFO) is present in 40% of patients with cryptogenic stroke and may be associated with paradoxical emboli to the brain. Therapeutic options include antiplatelet agents, anticoagulation, percutaneous device and surgical closure. We assessed the hypothesis that there are differences in rates of recurrent TIA or stroke between patients in the four treatment groups. Methods: Patients presenting from January 1997 with cryptogenic stroke or TIA and PFO were followed prospectively until June 2003. Treatment choice was made on an individual case basis. The primary outcome was recurrent stroke. The secondary outcome was a composite of stroke, TIA, and vascular death. Results: Baseline. Our cohort consisted of 121 patients; 64 (53%) were men. Median age was 43 years. Sixty-nine percent presented with stroke and 31% with TIA. One or more vascular risk factor was present in 40%. Atrial septal aneurysm (ASA) was present in 24%. Treatment consisted of antiplatelet agents (34%), anticoagulation (17%), device (39%) and surgical closure (11%). Follow-up. Recurrent events occurred in 16 patients (9 antiplatelet, 3 anticoagulation, 4 device closure); 7 were strokes, 9 were TIA. Comparing individual treatments there was a trend toward more strokes in the antiplatelet arm (p=0.072); a significant difference was seen for the composite endpoint (p=0.012). Comparing closure versus combined medical therapy groups, a significant difference was seen for primary (p=0.014) and secondary (p=0.008) outcomes, favoring closure. Age and pre-study event predicted outcome. Conclusion: Patent foramen ovale closure was associated with fewer recurrent events. Complications of surgical and device closure were self-limited.