卵圆孔未闭相关缺血性卒中的临床和神经影像学特征分析

目的 探讨卵圆孔未闭（patent foramen ovale，PFO）相关缺血性卒中的临床和神经影像学特征，并根据不同的PFO解剖特点，确定其缺血性病变类型是否存在差异。方法 本研究为单中心回顾性研究，入选2015年5月-2019年9月在首都医科大学附属北京天坛医院心血管内科连续住院接受PFO介入封堵治疗的缺血性卒中患者。所有患者均接受颅脑MRI检查，并通过TCD确定右向左分流（right-to-left shunt，RLS）量，经食道超声检查确定PFO诊断及其解剖结构。总结PFO相关缺血性卒中的影像学特征，并根据不同的PFO解剖特点，确定其缺血性病变类型是否存在差异。结果 共入组108例患者，平均年龄46±11岁，其中男性78例（72.2%）。PFO直径（静息状态）平均1.5±1.1 mm，雨帘状RLS 75例（69.4%），原发隔活瓣长度平均9.5±3.7 mm，长隧道型PFO 37例（34.3%），PFO伴过间隔血流76例（70.4%）。PFO相关缺血性卒中患者MRI显示梗死血管累及前循环42例（38.9%）（单侧前循环29例+双侧前循环13例），后循环39例（36.1%），皮层梗死22例（20.4%），皮层下梗死7例（6.5%），深部梗死 44例（40.7%），皮层、皮层下梗死+深部梗死35例（32.4%）；单一梗死31例（28.7%），多发梗死77例（71.3%）。不同的RLS量、PFO大小之间比较，脑梗死分布、梗死部位和梗死数量方面未发现影像学差异。长隧道组和非长隧道组的梗死部位（P =0.037）和梗死数量（P =0.016）差异均有统计学意义，其中长隧道组更多见皮层梗死（35.1% vs 12.7%）和单一梗死（43.2% vs 21.1%）。有过间隔血流组和无过间隔血流组在梗死分布上差异有统计学意义（P =0.014），有过间隔血流组后循环梗死发生率更高（43.4% vs 18.8%）。结论 PFO相关缺血性卒中患者影像学上梗死血管累及前循环和后循环的比率相似，梗死部位以深部梗死和多发梗死为主。长隧道型PFO与非长隧道型相比，皮层梗死和单一梗死更多见。伴有过间隔血流的PFO多发生后循环梗死。

Clinical and Neuroimaging Characteristics in Patients with Patent Foramen Ovale Related Ischemic Stroke

Objective To investigate the clinical and neuroimaging characteristics in patients with patent
foramen ovale (PFO) related ischemic stroke and examine whether the pattern of ischemic lesions
differ depending on the character of PFO anatomy.
Methods All consecutive ischemic stroke patients who underwent transcatheter closure of PFO
at Beijing Tian Tan Hospital between May 2015 and September 2019 were included in this
retrospective study. Brain magnetic resonance imaging was performed in all patients. Right-to-left shunt (RLS) was confirmed by contrast-enhanced transcranial Doppler bubble test and
PFO anatomy was determined by transesophageal echocardiography (TEE). The clinical and
neuroimaging characteristics were described and compared according to PFO anatomy.
Results A total of 108 patients were included in the study, with an average age of 46±11 years and 78
(72.2%) males. PFO size (rest state) was 1.5±1.1 mm and curtain effect in RLS occurred in 75 patients
(69.4%). The length of PFO channel was 9.5±3.7 mm and 37 patients (34.3%) had long PFO channel.
Blood flow via atrial septum was detected in 76 patients (70.4%). 22 cases (20.4%) with cortical
lesion, 7 (6.5%) with subcortical lesion, 44 (40.7%) with deep lesion and 35 (32.4%) with corticosubcortical
and deep lesions were observed on MRI. Moreover, there was no difference in cases with
posterior circulation infarct and anterior circulation infarct (36.1% vs 38.9%), and multiple lesions
more than single lesion (71.3% vs 28.7%). With different RLS degree and PFO size, there were no
imaging differences in infarct distribution, location and number. Long PFO channel patients were
more likely to have cortical infarct (35.1% vs 12.7%, P =0.037) and single infarct (43.2% vs 21.1%,
P =0.016). The ischemic lesions in patients with blood flow via atrial septum were predominantly
located in posterior circulation territory compared with those without blood flow via atrial septum
(43.4% vs 18.8%, P =0.014).
Conclusions The prevalence of anterior- and posterior-circulation infarct was similar in patients
with PFO-related ischemic stroke, with predominant deep infarct and multiple infarcts. Cortical
infarct and single infarct were more common in patients with long PFO channel, and posteriorcirculation
infarct was more common in patients with blood flow via atrial septum.