Management of the stroke patient with patent foramen ovale: new insights and persistent questions in the wake of recent randomized trials.
Management of the stroke patient with patent foramen ovale: new insights and persistent questions in the wake of recent randomized trials.
复制标题
卵圆孔未闭中风患者的治疗：最近随机试验后的新见解和持续存在的问题。
DOI：
10.1007/s11883-013-0338-4
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发表时间：
2013
影响因子：
5.8
通讯作者：
Kizer,JorgeR
中科院分区：
文献类型：
--
作者：
Peña,JessicaM;Kizer,JorgeR
不明原因中风或隐源性中风占所有缺血性中风的比例高达 30%。卵圆孔未闭（PFO）引起的反常栓塞被认为是隐源性脑缺血的潜在原因，特别是在年轻患者中。流行病学研究注意到 PFO 与隐源性中风之间存在关联，观察性研究表明经皮 PFO 封堵术比药物治疗具有潜在的优越性。然而，直到最近，还没有随机数据来检验 PFO 封堵可降低复发性脑缺血风险的假设。三项此类试验的发表，在意向治疗分析中均未能证明封闭治疗相对于药物治疗的治疗优势，但提供了该领域有价值的新数据。我们回顾了 PFO 和中风之间的流行病学证据以及最近评估不同治疗策略的观察性和随机试验数据。
Stroke without a known cause, or cryptogenic stroke, accounts for up to 30 % of all ischemic strokes. Paradoxical embolism through a patent foramen ovale (PFO) has been implicated as a potential cause of cryptogenic cerebral ischemia, particularly in young patients. Epidemiological studies have noted an association between PFO and cryptogenic stroke and observational studies have suggested the potential superiority of percutaneous PFO closure over medical therapy. However, until recently, there were no randomized data to test the hypothesis that PFO closure reduces the risk of recurrent cerebral ischemia. The publication of three such trials, all failing to demonstrate a therapeutic advantage for closure over medical therapy in intention-to-treat analyses, provides valuable new data in the field. We review epidemiological evidence linking PFO and stroke and recent observational and randomized trial data evaluating different treatment strategies.