Is Patent Foramen Ovale a Modifiable Risk Factor for Stroke Recurrence?
Is Patent Foramen Ovale a Modifiable Risk Factor for Stroke Recurrence?
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DOI：
10.1161/strokeaha.110.595140
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发表时间：
2010-10-01
期刊：
影响因子：
8.3
通讯作者：
Thaler, David E.
中科院分区：
文献类型：
--
作者：
Kent, David M.;Thaler, David E.
尽管卵圆孔未闭（PFO）在普通人群中的患病率约为25%，但在隐源性卒中（CS）患者中患病率约为两倍。这通常归因于矛盾栓塞，许多医生建议PFO关闭以防止复发。然而，PFO关闭对脑卒中患者的益处尚未得到证实。此外，有PFO的CS患者与无PFO的CS患者、有大右至左分流器的CS患者与小右至左分流器的CS患者卒中复发的流行病学结果似乎难以与矛盾栓塞是卒中复发的重要原因的假设相一致。本综述的目的是严格检查PFO是CS患者卒中复发的潜在可改变危险因素的流行病学证据。有证据表明，许多CS和PFO患者的卒中可归因于PFO，但许多卒中与PFO无关。我们引入了“PFO倾向”的概念，定义为在年龄和其他危险因素的基础上，CS患者发现PFO的患者特异性概率。我们表明，该值与CS归属于PFO的概率直接相关。由于PFO和CS患者的PFO倾向和复发风险存在很大的异质性，因此通过这些联合概率对PFO闭合进行分层可能对适当的患者选择至关重要。（中风。2010；41[增刊1]:S26-S30。）
Although the prevalence of a patent foramen ovale (PFO) in the general population is approximate to 25%, it is approximately doubled among cryptogenic stroke (CS) patients. This has generally been attributed to paradoxical embolism, and many physicians recommend PFO closure to prevent recurrence. However, the benefit of PFO closure in patients with stroke has not been demonstrated. Furthermore, the epidemiology of stroke recurrence in patients with CS with PFO versus without PFO and in those with large right-to-left shunts versus small right-to-left shunts has yielded results that appear difficult to reconcile with the hypothesis that paradoxical embolism is an important cause of stroke recurrence. The purpose of this review is to critically examine the epidemiologic evidence that PFO is a potentially modifiable risk factor for stroke recurrence in patients with CS. The evidence suggests that many patients with CS and PFO have strokes that are PFO attributable, but many have strokes that are unrelated to their PFO. We introduce the concept of "PFO propensity," defined as the patient-specific probability of finding a PFO in a patient with CS on the basis of age and other risk factors. We show that this value is directly related to the probability that CS is PFO attributable. Because there is substantial heterogeneity in both PFO propensity and recurrence risk among patients with PFO and CS, stratification for PFO closure by these joint probabilities will likely prove crucial for appropriate patient selection. (Stroke. 2010;41[suppl 1]:S26-S30.)