Patent foramen ovale and stroke
Patent foramen ovale and stroke
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DOI：
10.1007/s00415-018-8865-0
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发表时间：
2018-08-01
影响因子：
6
通讯作者：
Ferro, Jose M.
中科院分区：
文献类型：
--
作者：
Miranda, Bruno;Fonseca, Ana Catarina;Ferro, Jose M.
卵圆孔未闭（PFO）是隐源性缺血性卒中中非常普遍的发现，特别是在年轻人中。临床实践中的一个共同挑战是区分偶发性和致病性PFO。一些临床特征和工具，如矛盾栓塞风险评分，可能有助于确定卒中相关PFO的可能性。尽管如此，减少隐源性卒中合并PFO后卒中复发的最佳治疗选择一直是争论的焦点。我们回顾脑卒中相关PFO的发病机制，以及其临床特征和诊断标准。此外，我们将重点介绍二级预防领域新研究的方法学细节和结果。与先前的证据相反，最近三项临床试验和一项更新的荟萃分析的数据表明，在隐源性卒中/TIA后，PFO关闭比药物治疗更有利于预防卒中复发。除了短暂性心房颤动的发生率略有增加外，PFO闭合器手术与较高的死亡率或心血管事件无关。此外，房间隔动脉瘤和右至左分流较大的PFO患者关闭PFO的益处更高。未来的研究应该解决一些悬而未决的问题，如未进行PFO闭合的患者使用抗凝血剂或抗血小板的选择，PFO闭合后抗血小板治疗的持续时间以及PFO闭合在60岁以上患者中的作用。
A patent foramen ovale (PFO) is a highly prevalent finding in cryptogenic ischaemic stroke, particularly in young adults. A common challenge in clinical practice is to distinguish between incidental and pathogenic PFO. Some clinical features and tools such as the Risk of Paradoxical Embolism score may help determining the probability of a stroke-related PFO. Nonetheless, the best therapeutic option to reduce stroke recurrence after a cryptogenic stroke with PFO has been a matter of debate for a long time. We review the mechanisms of stroke-related PFO, together with its clinical features and diagnostic criteria. In addition, we focus on the methodological details and results from new studies in the field of secondary prevention. In contrast to prior evidence, the data from three recent clinical trials and an updated meta-analysis favour PFO closure over medical treatment after cryptogenic stroke/TIA for the prevention of stroke recurrence. The PFO closure device procedure is not associated with higher mortality or cardiovascular events, except for a small increase in the occurrence of transient atrial fibrillation. Furthermore, the benefit of PFO closure was higher among those with atrial septal aneurysm and PFO with large right-to-left shunt. Future studies should address pending issues such as the option for anticoagulants or antiplatelet in patients not undergoing closure, the duration of antiplatelet treatment after PFO closure and the role of PFO closure in patients older than 60.