房间隔结构异常致缺血性卒中患者的介入封堵治疗

目的 探讨经导管房间隔结构异常封堵治疗缺血性卒中患者的临床效果及预后。方法 以2015年5月至11月在首都医科大学附属北京天坛医院接受房间隔结构异常封堵治疗的缺血性卒中患者为研究对象。封堵术前,所有入选患者均经经颅多普勒超声(contrast transcranial Doppler ultrasound, cTCD)发泡试验证实有右向左分流(right-left shunt, RLS)以及经食管超声证实存在卵圆孔未闭(patent foramen ovale, PFO)或房间隔缺损(atrial septal defect, ASD)。封堵术后复查cTCD发泡试验及经胸超声心动图,观察手术效果,完全封堵及合并症情况,评价疗效及安全性。结果 本研究共纳入10例患者,平均年龄(48±14)岁,其中男性8例,女性2例, PFO患者8例,ASD患者2例。所有患者术前cTCD发泡试验均证实为大量RLS。PFO直径1.1~2.0 mm,平均(1.7±0.3)mm。ASD直径分别为4.5 mm和3.4 mm。手术成功率100%。8例PFO患者使用的封堵器型号均为18/25 mm,2例ASD封堵器的型号分别为12 mm和10 mm。封堵术后仅1例PFO患者在cTCD发泡试验中有中等量残余分流,完全封堵率90%。术后1、3、6个月随访,未见封堵器移位及表面血栓形成,未见脑缺血事件复发。结论 经导管PFO/ASD封堵术在缺血性卒中患者中应用是安全、有效的,能显著减少右向左分流,但需注意封堵术后中远期残余右向左分流的随访观察。

Transcatheter closure of atrial septal abnormalities(PFO,ASD) in patients with ischemic stroke

Objective To evaluate effective transcatheter atrial septal abnormalities (patent foramen ovale, PFO or atrial septal defect, ASD) closure rate and outcome in patients with ischemic stroke. Methods Ischemic stroke patients who underwent transcatheter closure of atrial septal abnormalities at Beijing Tiantan Hospital between May 2015 and November 2015 were enrolled. Right-left shunts (RLS) were confirmed by contrast transcranial Doppler ultrasound, and PFO or ASD were detected by transesophageal echocardiograph before transcatheter closure. Success rate of device implantation, completed closure rate and complications were evaluated. Results Ten patients [(48±14) years, 8 male and 2 female, 8 PFO and 2 ASD] were included in the study. Before closure, severe RLSs were detected in all patients. PFO size was (1.7±0.3) mm and ASD size was 4.5 mm and 3.4 mm. The procedure of device placement was successful in all patients. The 18/25 mm of PFO occluders were implanted in 8 PFO patients. The 12 mm and 10 mm ASD occluders were implanted in 2 ASD patients. Moderate residual RLS was present in 1 patient after PFO closure, and thus completed closure rate was 90%. Neither occluder malposition and thrombus,nor neurological recurrences were observed at 1, 3, and 6 months. Conclusion Transcatheter PFO or ASD closure is an effective and safe procedure in patients with ischemic stroke and can decrease RLS. However, it is necessary to evaluate residual RLS in mid-and long-term follow-up.