PATENT FORAMEN OVALE AND STROKE--A CASE CONTROL STUDY

通过卵圆孔未闭（PFO）进行栓塞， 被认为是缺血性中风的可能机制。 并存 深静脉血栓形成（DVT）和/或高凝状态可能 使PFO患者倾向于反常地栓塞大脑 循环，并可能解释目前标记的一些中风的起源 “隐源性的” 一个病例对照研究建议，以解决 以下目标： 1. 为了确定PFO是否是缺血性卒中的危险因素，特别是 隐源性卒中，发生在因年龄而患病的患者中;以及， 2. 确定PFO是否与DVT和/或高凝状态相关 中风患者，特别是那些隐源性中风。 次要目的是评估以下患者的2年卒中复发风险： 有和无PFO的患者，分流程度的差异 病例组和对照组之间的PFO，以及 高凝状态和中风 总共有300例缺血性卒中和300例无卒中对照， 参加这项为期3年的基于人群的病例对照研究。 研究 受试者将从正在进行的北方曼哈顿卒中研究中抽取 （NOMASS），这将确保招聘，同时大大减少 提案的成本。 PFO的存在将通过以下方式确定 经胸超声心动图和充气盐水注射。 评价 对于DVT病例，将通过多普勒超声进行检查。 一 高凝状态将被定义为存在升高的 凝血酶原片段F1.2水平，抗磷脂抗体，狼疮 抗凝剂或功能性蛋白S缺乏。 二年以来 在这项研究中，将对案件进行电话随访，以确定 死亡率和中风复发率。 将计算比值比，并使用逻辑回归分析， 判断潜在暴露变量的独立显著性。 根据检测到的相关性（PFO和卒中之间，以及 PFO和DVT和/或高凝状态之间），研究将设定 临床试验的基础，以评估治疗方案的疗效 （抗凝、PFO封堵）降低卒中复发率。

Paradoxical embolization through a patent foramen ovale (PFO) is considered a possible mechanisms for ischemic stroke. The coexistence of a deep vein thrombosis (DVT) and/or a hypercoagulable state might predispose patients with PFO to paradoxically embolize to the cerebral circulation, and may explain the origin of some strokes currently labeled as "cryptogenic". A case-control study is proposed to address the following aims: 1. To determine if PFO is a risk factor for ischemic stroke, especially cryptogenic stroke, in patients unselected for age; and, 2. To determine if PFO is associated with DVT and/or hypercoagulable states in stroke patients, especially those with cryptogenic stroke. Secondary aims will be to evaluate the 2-year stroke recurrence risk in patients with and without PFO, differences in the degree of shunt through the PFO between cases and controls, and the potential association between hypercoagulable states and stroke. A total of 300 cases of ischemic stroke and 300 stroke-free controls will be enrolled in this 3-year population-based case-control study. Study subjects will be drawn from the ongoing Northern Manhattan Stroke Study (NOMASS), which will assure recruitment while significantly reducing the cost of the proposal. The presence of a PFO will be ascertained by transthoracic echocardiography with aerated saline injection. Evaluation for DVT in cases will be performed by Doppler ultrasound. A hypercoagulable state will be defined as the presence of elevated prothrombin fragment F1.2 levels, antiphospholipid antibodies, Lupus anticoagulant or functional Protein S deficiency. From the second year of the study, a telephone follow-up will be carried out on cases to ascertain mortality and stroke recurrence. Odds ratios will be calculated and logistic regression will be used to judge the independent significance of the potential exposure variables. On the basis of the associations detected (between PFO and stroke, and between PFO and DVT and/or hypercoagulable states), the study will set the ground for clinical trials to assess the efficacy of therapeutic options (anticoagulation, PFO closure) in reducing the stroke recurrence rate.