经导管封堵术治疗不明原因卒中合并卵圆孔未闭患者的临床疗效及预后  

Efficacy and outcome of transcatheter closure of patent foramen ovale in patients with cryptogenic stroke

作　　者：付强[1] 郭彩霞[1] 杜丽娟[2] 白亚秋[3] 龚浠平[3] 鞠奕[3] 陆菁菁[3] 胡建科[3] 曲辉[3] 董可辉[3] 陈步星[1] 王拥军[3] Fu Qiang;Guo Caixia;Du Lijuan;Bai Yaqiu;Gong Xiping;Ju Yi;Lu Jingjing;Hu Jianke;Qu Hui;Dong Kehui;Chen Buxing;Wang Yongjun(Department of Cardiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京天坛医院心血管内科,100050 [2]首都医科大学附属北京天坛医院超声科,100050 [3]首都医科大学附属北京天坛医院血管神经病学科,100050

出　　处：《中华心血管病杂志》2018年第11期882-886,共5页Chinese Journal of Cardiology

摘　　要：目的 探讨经导管封堵术治疗不明原因卒中合并卵圆孔未闭(PFO)的临床疗效及预后.方法 本研究为前瞻性研究.连续入选2015年5月至2017年9月在北京天坛医院心血管内科接受经导管PFO封堵术治疗的不明原因卒中合并PFO患者60例.所有入选患者均经颅多普勒超声(TCD)增强试验证实存在右向左分流.随访观察经导管PFO封堵术成功率、有效封堵率、并发症、脑缺血事件及新发心房颤动的发生情况.结果 本研究最终入选不明原因卒中合并PFO患者60例,其中男性42例,女性18例,年龄24~68(47±11)岁,PFO直径(静息状态)(1.6±0.6)mm.术前右向左分流量,中量者11例,大量者48例(其中淋浴状及雨帘状分流者41例).经导管PFO封堵术成功率为100%(60/60),无严重围手术期并发症.术后随访2~29个月(中位数12个月),术后6个月45例患者完成TCD增强试验随访,其中,中、大量残余右向左分流者4例,有效封堵率达91%(41/45).随访期间,仅1例患者脑梗死复发,无新发心房颤动发生.结论 经导管PFO封堵术治疗不明原因卒中合并PFO安全、有效,预后良好.Objective To investigate the efficacy and outcome of transcatheter patent foramen ovale (PFO) closure in patients with cryptogenic stroke (CS). Methods Sixty consecutive patients with cryptogenic stroke who undertook transcatheter PFO closure between May 2015 and September 2017 in Beijing Tiantan Hospital were enrolled in this prospective study.Transcranial Doppler (TCD) bubble test was performed and right-left shunt(RLS) was confirmed in all patients.Closure success rate,effective closure rate, complications, recurrence of ischemic stroke and new onset atrial fibrillation were evaluated. Results A total of 60 patients (42 male,age range 24-68 (47±11)years) were included in the study.PFO size (motionless state) was (1.6±0.6)mm.RLS before closure was graded and 11 patients had moderate RLS and 48 patients had large RLS (include 41 patients who experienced shower or curtain effect).Closure success rate was 100% (60/60).No severe complications were observed.At 6 months,45 patients completed TCD bubble test.Of these, 4 patients suffered from moderate to large residual and thus effective closure rate was 91%(41/45).The mean follow-up period was 2-29 (median 12) months. During the follow-up, only 1 patient experienced recurrent cerebral infarction.New onset atrial fibrillation was not detected.Conclusion Transcatheter PFO closure is effective,safe and related with a good outcome in reduction of recurrent CS for patients with PFO.

关 键 词：卒中 卵圆孔 未闭 经导管封堵术 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R654.2[医药卫生—临床医学]