Kraywinkel K, Jauss M, Diener H-C, Weimar C
Neurologische Klinik, Universität Duisburg-Essen.
Nervenarzt. 2005 Aug;76(8):935-42. doi: 10.1007/s00115-004-1874-5.
The role of a patent foramen ovale (PFO) in stroke is still regarded as controversial, as is the optimal strategy of secondary prevention for such patients. The best available evidence is derived from case-control studies, which in all show a statistically significant relationship but cannot be judged as conclusive for methodologic reasons. Besides paradoxic embolism, different pathomechanisms of stroke due to abnormalities of the atrial septum are possible that can rarely be verified in clinical routine. While the risk of stroke recurrence seems to be low at least for younger patients, to date no definite recommendations for secondary prevention can be given. Several ongoing randomized clinical trials might increase the store of evidence in this topic over the next years. However, primary and secondary risk seem to be substantially increased for the combined defect of PFO and atrial septum aneurysm. To allow further risk stratification, other potentially important factors such as shunt size and coagulation disorders should be targeted in future studies.
卵圆孔未闭（PFO）在中风中的作用仍存在争议，此类患者二级预防的最佳策略同样如此。现有最佳证据来自病例对照研究，所有这些研究均显示出具有统计学意义的关系，但由于方法学原因，不能判定为结论性证据。除反常栓塞外，因房间隔异常导致中风的不同病理机制也是可能的，而这些在临床常规中很少能得到证实。虽然至少对于年轻患者而言，中风复发风险似乎较低，但迄今为止，无法给出明确的二级预防建议。未来几年，几项正在进行的随机临床试验可能会增加该主题的证据储备。然而，对于PFO和房间隔瘤合并缺损，一级和二级风险似乎会大幅增加。为了进一步进行风险分层，未来研究应针对其他潜在重要因素，如分流大小和凝血障碍。
