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隐源性卒中约占所有缺血性卒中的40%,其病因、诊断和治疗一直是临床工作者的研究热
点。近年来发现,卵圆孔未闭与隐源性卒中的发病密切相关,是隐源性卒中的重要危险因素。在临床
中常用经食管超声心动图、经胸壁超声心动图、经颅多普勒发泡试验和心脏MRI等方法来检测卵圆孔
未闭。反常栓塞是卵圆孔未闭导致隐源性卒中的主要发病机制。在头部影像学检查中,绝大多数卵圆
孔未闭相关隐源性卒中患者为多血管分布区的多发散在小梗死。在药物治疗方面,抗血小板药物相
对于抗凝药物,可能更适合大多数卵圆孔未闭合并隐源性卒中的患者。此外,近期多项临床随机对照
研究均表明,卵圆孔未闭封堵术对于预防卵圆孔未闭合并隐源性卒中患者卒中再发的疗效明显优于
药物治疗。 相似文献
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经过全面筛查,仍有约40%找不到明确病因的缺血性卒中为隐源性卒中。卵圆孔未闭可引
起反常栓塞,进而发生缺血性卒中。近年来发现,部分隐源性卒中可能由卵圆孔未闭导致。本文将从
检查方法、作用、机制及治疗等方面对卵圆孔未闭与隐源性卒中的研究现状进行介绍。 相似文献
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Mehmet Akif Topcuoglu Ethem Murat Arsava 《Journal of stroke and cerebrovascular diseases》2019,28(6):1636-1639
Background and Purpose: The routine use of percutaneous transcatheter patent foramen ovale closure (PPFOC) to prevent recurrent stroke in patients with cryptogenic stroke is still a matter of debate after completion major randomized controlled trials (RCTs). Methods: The fragility index of RCTs evaluating effect of PPFOC against medial therapy alone in stroke prevention was calculated to assess the robustness of statistically significant findings. Results: Literature search with PubMed identifies 6 RCTs on PPFOC. Median number of patients who underwent PPFOC and medical treatment were 340 and 229, respectively. Median number of the patients lost to follow-up was 20 in PPFOC and 18 in medical group. Fragility index was 0 for 4 studies. Median fragility index was also 0 for both “stroke” (interquartile range: 0-5.3) and “combined stroke and TIA” (interquartile range: 0-2) endpoints. In all studies except CLOSE, fragility index was smaller than or equal to the number of the subjects lost to follow-up. Conclusions: Recent positive results of PFO closure studies should be interpreted cautiously because of their fragile characteristics. Routine PFO closure should be reserved for prevention of recurrence when suspicion for paradoxical embolism is high. Detailed individualized decision-making is crucial before ordering PPFOC for stroke prevention in patients with cryptogenic embolism. 相似文献
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Yohei Tateishi Yuji Ueno Akira Tsujino Ayako Kuriki Yuki Kamiya Takahiro Shimizu Ryosuke Doijiri Eriko Yamaguchi Muneaki Kikuno Yoshiaki Shimada Hidehiro Takekawa Masatoshi Koga Masafumi Ihara Koichi Hirata Yasuhiro Hasegawa Kazunori Toyoda Nobutaka Hattori Takao Urabe 《Journal of stroke and cerebrovascular diseases》2021,30(8):105892
ObjectiveSome cardiac abnormalities could be a substrate for potential embolic source in cryptogenic stroke (CS). We evaluated whether cardiac and echocardiographic markers were associated with CS in patients with incidental patent foramen ovale (PFO) as defined using the Risk of Paradoxical Embolism (RoPE) score.Materials and methodsAmong 677 patients enrolled in a multicenter observational CS registry, 300 patients (44%) had PFOs detected by transesophageal echocardiography. They were classified into probable PFO-related stroke (RoPE score>6, n = 32) and stroke with incidental PFO (RoPE score≤6, n = 268) groups, and clinical characteristics, laboratory findings, cardiac and echocardiographic markers (i.e. brain natriuretic peptide, left atrial [LA] diameter, ejection fraction, early transmitral flow velocity/early diastolic tissue Doppler imaging velocity [E/e’], LA appendage flow velocity, spontaneous echo contrast, atrial septal aneurysm, substantial PFO, and aortic arch plaques), stroke recurrence, and excellent outcome (modified Rankin scale score <2) at discharge were compared. Risk factors for low RoPE scores were determined using multiple logistic regression analysis.ResultsHigher brain natriuretic peptide levels (p = 0.032), LA enlargement (p < 0.001), higher E/e’ (p = 0.001), lower LA appendage flow velocity (p < 0.001), non-substantial PFO (p = 0.021), and aortic arch plaques (p = 0.002) were associated with the low RoPE score group. Patients with high RoPE scores had excellent outcomes (58% versus 78%, p = 0.035). LA enlargement (age- and sex-adjusted odds ratio, 1.15; 95 % confidence interval, 1.00–1.32; p = 0.039) was an independent predictor of low RoPE scores.ConclusionsAbnormal cardiac substrate could be associated with CS occurrence in a subset of patients with PFO. Patients with CS who had incidental PFO may be at risk of cardioembolism. 相似文献
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卵圆孔未闭与缺血性卒中 总被引:3,自引:1,他引:2
1卵圆孔未闭与隐源性卒中的关系胎儿时期,肺不能接受血流,返回到右心房的血液是通过开放的卵圆孔分流至左心房的。出生后,约75%的人卵圆孔自动关闭,而25%的人发生卵圆孔未闭(patent foramen ovale, PFO)。卵圆孔未闭不影响血流动力学,正常情况下,卵圆窝膜可阻挡左向右的分流,当右房压力升高时,卵圆孔重新开放,为奇异性栓塞(如矛盾性栓塞,反常性栓塞,paradoxical embolism)提供了一个管道。 相似文献
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Jeonggeun Moon Minsu Kim Pyung Chun Oh Dong Hoon Shin Hyeon-MI Park Youn Yi Jo Ji Sung Lee Woong Chol Kang 《Journal of stroke and cerebrovascular diseases》2019,28(2):347-353
Background
Percutaneous closure of patent foramen ovale (PFO) is an alternative option to medical treatment for secondary prevention for cryptogenic stroke (CS). Despite technical success of procedure, residual shunt (RS) which is a presumable cause for recurrent stroke is observed in some patients. We evaluated the RS with serial follow-up bubble contrast transesophageal echocardiography (BCTEE) after PFO closure.Methods
Among consecutive 47 CS patients who underwent PFO closure, a serial follow-up BCTEE at 3 and 9 months after the index procedure was completed in 38 patients (81%, 46 ± 10 years, 19 men). To evaluate the efficacy of PFO closure, the incidence of any and significant RS (≥ moderate) was assessed.Results
All PFO closure procedures were successful. The Amplatzer PFO Occluder (n?=?19) or the Gore Septal Occluder (n?=?19) were used. Any RS was observed in 13 (34%) and 10 patients (26%) at 3 and 9 months after the procedure. Significant RS was observed in 6 (16%) and 4 (11%) patients at 3- and 9-month follow-up BCTEE. Patients who were treated with the Gore Septal Occluder have a less incidence of any RS in 3 months, and any/significant RS in 3- and 9-month follow-up BCTEE without statistical significance.Conclusions
RS grade keeps decreasing after PFO closure, but it remains even after 9 months in some patients. Incomplete sealing of PFO should be taken into consideration in management of CS patients even after technically successful PFO closure. 相似文献12.
Luigi Caputi Gianfranco Butera Gian Paolo Anzola Mario Carminati Maria Rita Carriero Massimo Chessa Eustaquio Onorato Gianluca Rigatelli Giuseppe Sangiorgi Gennaro Santoro Isabella Spadoni Gian Paolo Ussia Carlo Vigna Mario Zanchetta Eugenio Parati 《Journal of stroke and cerebrovascular diseases》2013,22(7):e219-e226
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Baoshan Qiu Ying Cai Dilong Wang Jing Lin Yuhua Fan 《Journal of stroke and cerebrovascular diseases》2018,27(12):3463-3472
Background
Debate continues about whether percutaneous closure of patent foramen ovale (PFO) is a better strategy for the treatment of patients with cryptogenic stroke in comparison with medical therapy alone. We performed an updated meta-analysis of 6 randomized controlled trials (RCTs) to assess the effectiveness and safety of percutaneous closure of PFO as secondary prevention for patients with previous cryptogenic stroke compared to medical therapy.Materials and Methods
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, conference proceedings, and Internet-based resources were retrieved in March 2018 for eligible RCTs. The primary effectiveness outcome was recurrent strokes.Results
Six studies meeting our selection criteria were identified. Among 3560 participants, 1889 patients were assigned to PFO closure and 1671 patients to medical therapy. There were no significant differences among the baseline characteristics. The pooled incidence of recurrent strokes was 1.96% in the PFO closure group and 4.60% in the medical therapy group (Relative risk [RR] .39, 95% confidence interval [CI] .18-.82, P?=?.01). Newly detected atrial fibrillation occurred in 77 of 1844 (4.18%) patients in the PFO closure group and in 12 of 1667 (.72%) patients in the medical therapy group (RR 4.56, 95% CI 2.21-9.41, P <.0001). There was no difference in terms of serious adverse events, total mortality or bleeding between 2 groups.Conclusions
Our updated meta-analysis suggests that in patients with PFO and cryptogenic stroke, the rate of recurrent stroke is significantly reduced with percutaneous closure of PFO compared to the medical therapy. 相似文献15.
<正>1病例介绍患者男性,34岁,因"左侧肢体无力伴言语不利2 d"于2014年10月27日入院。入院前2 d,患者饮酒后约19 h出现左侧上下肢无力,不能持物,不能行走,伴言语不利,且饮水呛咳,就诊于首都医科大学附属同仁医院予以输液治疗1 d(具体不详),于1 d前转入首都医科大学附属北京天坛医院急诊,行头颅计算机断层扫描(computed tomography,CT)检查示右侧额、颞、岛叶及基底节区梗死灶,为求进一步诊 相似文献
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正随着缺血性卒中分型理论在国内的普及[1-2],人们越来越重视针对卒中病因的筛查和研究。病因不同,缺血性卒中二级预防的策略就可能不同,如心源性卒中侧重于抗凝治疗,而大动脉粥样硬化性卒中则强调抗血小板聚集。近年,所谓隐源性卒中的病因研究,在国内逐渐受到重视。本文将简要介绍隐源性卒中研究中所涉及的相关问题,重点阐述卵圆孔未闭(patent foramen ovale,PFO)在缺血性卒中发病中的 相似文献
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Sachie Inoue Ataru Igarashi Yasuyuki Iguchi Teiji Akagi 《Journal of stroke and cerebrovascular diseases》2021,30(8):105884
ObjectivesPatent foramen ovale is a hemodynamically insignificant interatrial communication that may cause ischemic stroke. Percutaneous patent foramen ovale closure reduces the risk for recurrent ischemic stroke in patients with a history of cryptogenic ischemic stroke. This study evaluated the cost-effectiveness of patent foramen ovale closure against medical therapy in patients after their first cryptogenic ischemic stroke in Japan.Materials and methodsThe cost-effectiveness of patent foramen ovale closure compared with medical therapy was evaluated using the Markov model. The target patients started with patent foramen ovale closure or medical therapy for preventing secondary ischemic stroke under a stable state. Quality-adjusted life year was used as the outcome of effectiveness, and the analysis was conducted with a discount rate of 2% applied to both cost and effectiveness. The results of a multicenter open-label randomized controlled trial (RESPECT trial) evaluating patent foramen ovale closure using the Amplatzer? PFO Occluder were used as clinical evidence. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio. It was evaluated as cost-effective if it was lower than 5 million JPY/ quality-adjusted life year.ResultsPatent foramen ovale closure was dominant over medical therapy by 2.53 quality-adjusted life years and an estimated cost reduction of 2,353,926 JPY. The probability of patent foramen ovale closure being dominant was 82.9%.ConclusionsPatent foramen ovale closure was dominant over medical therapy for preventing secondary ischemic stroke in patients with cryptogenic ischemic stroke. 相似文献
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反常性栓塞风险量表在合并卵圆孔未闭的隐源性卒中或短暂性脑缺血发作患者中的应用 总被引:1,自引:0,他引:1
郑华光 ;王伊龙 ;陈启东 ;曲辉 ;胡建科 ;苑晓春 ;陆菁菁 ;鞠奕 ;宁彬 ;何文 ;付强 ;陈步星 ;刘丽萍 ;杨中华 ;王春雪 ;董可辉 ;赵性泉 ;王拥军 《中国卒中杂志》2014,9(8):654-662
目的 描述卵圆孔未闭(patent foramen ovale,PFO)造成反常性栓塞(paradoxical embolism,PE)的临
床表现、影像学特点。验证反常性栓塞风险量表(Risk of Paradoxical Embolism,RoPE)评分。
方法 本研究为单中心观察性研究,连续性入选2013年1月~2014年6月首都医科大学附属北京天
坛医院神经科收治的隐源性卒中或短暂性脑缺血发作(transient ischemic attack,TIA)患者79例,其
中经经颅多普勒超声发泡试验(contrast-enhanced transcranial Doppler,cTCD)和经食管超声心动图
(transesophageal echocardiography,TEE)确诊合并PFO的患者44例,其中37例为PFO所致PE,7例仅合并
PFO无栓塞症状。由另一名神经科医师盲法评价颅脑磁共振成像,确定其影像学的特点,收集两组
患者的人口学信息,临床资料,相关辅助检查(如cTCD、TEE、颈部血管超声及双下肢静脉超声结果),
计算并比较两组RoPE评分情况。PFO所致PE患者根据PFO大小分为3组,依据右向左分流量(rightto-
left shunt,RLS)大小分为3组。比较不同PFO大小和不同RLS患者之间的临床和影像学特点,并评
估不同PFO大小和不同RLS之间的关联性及RoPE评分与PFO的大小和RLS的严重程度之间的关系。
结果 两组的RoPE评分分别为5(4.5,7.0)和6(4.0,8.0),差异无显著性(P>0.05)。合并颈内
动脉重度狭窄或闭塞,高度提示非PFO相关缺血性卒中(P<0.01)。小PFO组(<2 mm)和中/大PFO组
(≥2 mm)相比较,两组的RoPE评分分别为(5.5±1.9 vs 6.3±2.0,P>0.05),后者更容易累及后循
环。不同RLS患者之间相比较,3组的RoPE评分分别为(5.4±1.7,6.5±2.7,5.8±2.0,P>0.05)。PFO
大小和RLS之间无显著性相关(r =0.031,P>0.05)。
结论 PFO和脑梗死的关系可以分为:无相关性(即PFO合并存在)或有相关性(即PE),PE的影像学
特点和PFO大小有一定的相关性。RoPE可能有助于进一步区分PFO的大小和RLS的严重程度。 相似文献