封堵术对缺血性脑卒中合并卵圆孔未闭患者的近期安全性及疗效评价
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摘要
目的研究封堵术对缺血性脑卒中合并卵圆孔未闭(PFO)患者的近期安全性及疗效。方法分析2016年6月至2018年9月于河北医科大学第二医院神经内科就诊、经胸超声心动图声学造影(cTTE)和经食道超声心动图(TEE)检查同时确诊PFO的缺血性脑卒中患者56例,根据患者分为PFO封堵手术组(n=34)和非手术组(n=22),收集患者的一般临床资料,随访手术后患者的并发症情况并比较两组患者的预后情况。结果手术组94.1%患者成功置入封堵器,术中及术后无严重并发症发生。平均随访时间(8.79±5.75)个月,结果显示,两组都没有出现死亡和再次住院等严重不良后果,手术组缺血性脑卒中复发患者比例(2.8%)显著低于非手术组(25%,P=0.034)。所有手术患者于术后6～12个月复查心脏彩超均未见封堵器移位、脱落、血栓形成,心房水平未见分流,复查心电图无房颤等心律失常发生。手术组偏头痛患者头痛影响测定-6(HIT-6)评分(39.33±5.10)显著低于非手术组(66.83±1.33),且与术前(67.22±1.56)相比显著降低(P<0.05)。结论 PFO封堵术可作为缺血性脑卒中合并PFO患者,预防卒中再发及改善偏头痛症状的一种安全有效的治疗方案。
Objective To investigate the clinical safety and efficacy of transcatheter closure in ischemic stroke patients with patent foramen ovale(PFO). Method This prospective clinical trial enrolled 56 ischemic stroke patients with PFO from Department of Neurology, the Second Hospital of Hebei Medical University from June 2016 to September 2018, in which PFO was diagnosed by contrast transthoracic echocardiography(cTTE) and transesophageal echocardiography(TEE). Subjects were grouped according to their selection of PFO closure. 34 patients were allocated to treatment with PFO closure. 22 patients were assigned to control group with medical treatment. The clinical data and followup were collected. Results 94.1% patients were successful in closure without any complications both in hospital and in follow-up period. There was no death or readmission in both groups. The recurrence of ischemic stroke and the mean scores of headache impact test-6(HIT-6) in the surgical group(2.8%, 39.33±5.10) were significantly reduced compared with control group(25%, 66.83±1.33), and the mean scores of HIT-6 in surgical group were significantly lower than their previous scores(67.22±1.56). Conclusion Transcatheter closure is safety and efficacy in reducing the recurrence of ischemic cerebrovascular event in ischemic stroke patients with PFO and improving symptoms caused by migraine.
Objective To investigate the clinical safety and efficacy of transcatheter closure in ischemic stroke patients with patent foramen ovale(PFO). Method This prospective clinical trial enrolled 56 ischemic stroke patients with PFO from Department of Neurology, the Second Hospital of Hebei Medical University from June 2016 to September 2018, in which PFO was diagnosed by contrast transthoracic echocardiography(cTTE) and transesophageal echocardiography(TEE). Subjects were grouped according to their selection of PFO closure. 34 patients were allocated to treatment with PFO closure. 22 patients were assigned to control group with medical treatment. The clinical data and followup were collected. Results 94.1% patients were successful in closure without any complications both in hospital and in follow-up period. There was no death or readmission in both groups. The recurrence of ischemic stroke and the mean scores of headache impact test-6(HIT-6) in the surgical group(2.8%, 39.33±5.10) were significantly reduced compared with control group(25%, 66.83±1.33), and the mean scores of HIT-6 in surgical group were significantly lower than their previous scores(67.22±1.56). Conclusion Transcatheter closure is safety and efficacy in reducing the recurrence of ischemic cerebrovascular event in ischemic stroke patients with PFO and improving symptoms caused by migraine.
引文
[1] Lechat P, Mas JL, Lascault G, et al. Prevalence of patent foramen ovale in patients with stroke[J]. N Engl J Med, 1988, 318(18):1148-1152.
[2]Han SW, Kim SH,Lee JY, et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism[J].Eur Neurol, 2007, 57(2):96-102.
[3] Ozdemir AO, Tamayo A, Munoz G, et al. Cryptogenic stroke and patent foramen ovale:clinical clues to paradoxical embolism[J]. J Neurol Sci, 2008, 275(1-2):121-127.
[4]Bridges ND,Hellenbrand W, Latson L,et al. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism[J].Circulation, 1992, 86(6):1902-1908.
[5] Kent DM, Buthazer R, Weimar C, et al. An index to identify strokerelated vs. incidental patent foramen ovale in cryptogenic stroke[J].Neurology, 2013, 81(7):619-625.
[6]Hagen PT, Seholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life:an autopsy study of965 normal hearts[J]. Mayo Clin Proc, 1984, 59(1):17-20.
[7]Tariq N,Tepper SJ,Kriegler JS. Patent foramen ovale and migraine:closing the debate——A Review[J].Headache,2016,56(3):462-478.
[8]Nozari A, Dilekoz E,Sukhotinsky I, et al. Microemboli may link spreading depression, migraine aura, and patent foramen ovale[J].Ann Neurol, 2010, 67(2):221-229.
[9] Trabattoni D, Fabbiocchi F, Montorsi P, et al. Sustained long-term benefit of patent foramen ovale closure on migraine[J]. Catheter Cardiovasc Interv, 2011, 77(4):570-574.
[10]Carroll JD,Saver JL, Thaler DE, et al. Closure of patent foramenovale versus medical therapy after cryptogenic stroke[J]. N Engl J Med, 2013, 368(12):1092-1100.
[11]Meier B,Kalesan B,Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism[J]. N Engl J Med, 2013,368(12):1083-1091.
[12] Furlan AJ, Reisman M, Massaro J, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale[J]. N Engl J Med, 2012, 366(11):991-999.
[13] Wolfrum M, Froehlich GM, Knapp G, et al. Stroke prevention by percutaneous closure of patent foramen ovale:a systematic review and meta-analysis[J]. Heart, 2014, 100(5):389-395.
[14] Kent DM, Dahabreh IJ, Ruthazer R, et al. Device closure of patenl foramen ovale after stroke:pooled analysis of completed randomized trials[J]. J Am Coll Cardiol, 2016, 67(8):907-917.
[15] Wahl A, J u ni P, Mono ML, et al. Long-term propensity scorematched comparison of percutaneous closure of patent foramen ovale with medical treatment after paradoxical embolism[J].Circulation, 2012, 125(6):803-12.
[16] Stortecky S, da CBR, Mattle HP, et al. Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism:a network meta-analysis[J]. Eur Heart J, 2015, 36(2):120-128.
[2]Han SW, Kim SH,Lee JY, et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism[J].Eur Neurol, 2007, 57(2):96-102.
[3] Ozdemir AO, Tamayo A, Munoz G, et al. Cryptogenic stroke and patent foramen ovale:clinical clues to paradoxical embolism[J]. J Neurol Sci, 2008, 275(1-2):121-127.
[4]Bridges ND,Hellenbrand W, Latson L,et al. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism[J].Circulation, 1992, 86(6):1902-1908.
[5] Kent DM, Buthazer R, Weimar C, et al. An index to identify strokerelated vs. incidental patent foramen ovale in cryptogenic stroke[J].Neurology, 2013, 81(7):619-625.
[6]Hagen PT, Seholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life:an autopsy study of965 normal hearts[J]. Mayo Clin Proc, 1984, 59(1):17-20.
[7]Tariq N,Tepper SJ,Kriegler JS. Patent foramen ovale and migraine:closing the debate——A Review[J].Headache,2016,56(3):462-478.
[8]Nozari A, Dilekoz E,Sukhotinsky I, et al. Microemboli may link spreading depression, migraine aura, and patent foramen ovale[J].Ann Neurol, 2010, 67(2):221-229.
[9] Trabattoni D, Fabbiocchi F, Montorsi P, et al. Sustained long-term benefit of patent foramen ovale closure on migraine[J]. Catheter Cardiovasc Interv, 2011, 77(4):570-574.
[10]Carroll JD,Saver JL, Thaler DE, et al. Closure of patent foramenovale versus medical therapy after cryptogenic stroke[J]. N Engl J Med, 2013, 368(12):1092-1100.
[11]Meier B,Kalesan B,Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism[J]. N Engl J Med, 2013,368(12):1083-1091.
[12] Furlan AJ, Reisman M, Massaro J, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale[J]. N Engl J Med, 2012, 366(11):991-999.
[13] Wolfrum M, Froehlich GM, Knapp G, et al. Stroke prevention by percutaneous closure of patent foramen ovale:a systematic review and meta-analysis[J]. Heart, 2014, 100(5):389-395.
[14] Kent DM, Dahabreh IJ, Ruthazer R, et al. Device closure of patenl foramen ovale after stroke:pooled analysis of completed randomized trials[J]. J Am Coll Cardiol, 2016, 67(8):907-917.
[15] Wahl A, J u ni P, Mono ML, et al. Long-term propensity scorematched comparison of percutaneous closure of patent foramen ovale with medical treatment after paradoxical embolism[J].Circulation, 2012, 125(6):803-12.
[16] Stortecky S, da CBR, Mattle HP, et al. Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism:a network meta-analysis[J]. Eur Heart J, 2015, 36(2):120-128.