卵圆孔未闭并隐源性卒中的临床及影像学分析

目的探讨卵圆孔未闭(patent foramen ovale,PFO)并隐源性卒中(cryptogenic stroke,CS)的临床及影像学特征。方法连续性纳入2015年3月~2015年12月入住郑州大学附属洛阳中心医院神经内科的年龄≤65岁的急性缺血性脑卒中患者,对其进行脑血管病危险因素筛查,并行TOAST分型。对所有入组患者通过经胸超声心动图声学造影(c TTE)联合经颅多普勒声学造影(c TCD)(即发泡试验)行PFO筛查,两者均为阳性视为存在PFO。分析PFO在急性缺血性卒中中检出率,及PFO并CS的分流量、影像学分布特征及部分封堵术后疗效观察。结果共纳入141例符合标准的急性缺血性卒中患者。隐源性卒中48例(34.0%),非隐源性卒中93例(66.0%)。PFO阳性率在缺血性卒中组、CS组、非CS组中分别为31.2%(44/141)、47.9%(23/48)、22.6%(21/93)。PFO阳性组中,隐源性卒中较非隐源性卒中存在较大的分流量,且差异有统计学意义(P=0.007)。而PFO相关性隐源性卒中与非PFO相关性隐源性卒中患者在其病灶分布的部位、数量之间的差异无统计学意义。PFO封堵术后6月随访未见复发,但尚缺乏对照性研究。结论 PFO及其分流量与CS密切相关,但PFO并CS患者无特异性影像学表现,应加强对此类患者的筛查与管理。

Clinical and imaging analysis of cryptogenic stroke with patentf oramen ovale

Object ive To investigate the clinical and imaging features of cryptogenic stroke (CS) with patent fora-men ovale (PFO).Methods The patients with acute ischemic stroke (AIS) of age≤65 years were recruited at Depart-ment of Neurology,Luoyang Central Hospital Affiliated to Zhengzhou University from March 2015 to December 2015.All the patients were performed cerebrovascular disease risk factor screening and were divided into five subtypes based on TOAST classification.Contrast transthoracic echocardiography ( cTTE) and contrast transcranial doppler (cTCD) were used to detect the presence of PFO.The prevalence of PFO in AIS were was analyzed as well as the shunt volume and ima-ging features of CS with PFO.Meanwhile,we observed the effect of transcatheter closure on some PFO patients.Results A total of 141 AIS patients were enrolled,which contained 48 CS subjects (34%) and 93 non-CS subjects.The frequency of PFO in AIS group,CS group,non-CS group was respectively 31.2% (44 /141),47.9% (23/48),22.6% (21 /93) re-spectively.In the PFO group,lager shunt was observed in CS subgroup than non-CS subgroup (P =0.007).There were no significant differences in this two subgroups.The cerebral ischemic event recurrence among patients with device closure was not observed in the six-month follow-up.Conclusion PFO and shunt volume were closely related with CS.But,CS with PFO patients have no special imaging features.More efforts should employed in PFO detection in CS and the management of CS with PFO.