Cerrato P, Priano L, Imperiale D, Bosco G, Destefanis E, Villar A M, Ribezzo M, Trevi G P, Bergamasco B, Orzan F
First Division of Neurology, University of Turin, Italy.
Neurol Sci. 2006 Feb;26(6):411-8. doi: 10.1007/s10072-006-0524-z.
The aim of this study was to evaluate the risk of recurrent ischaemic cerebrovascular events (stroke or transient ischaemic attack (TIA)) in patients with patent foramen ovale (PFO) or atrial septal aneurysm (ASA) treated with different therapeutic regimens. We enrolled 86 patients aged 18-60 years with an unexplained ischaemic stroke or TIA referred to our inpatient department in the period May 1994-December 1999. Follow-up lasted until April 2003. Patients were excluded if the stroke or TIA was related to large-artery atherosclerosis, small artery occlusion, major cardiac sources of embolism or other uncommon causes. During a follow-up (mean+/-SD) of 64.1+/-28.8 months (range 8.1-105.6) a recurrent ischaemic cerebrovascular event occurred in 11/86 patients (12.8%) (5 TIA and 6 strokes). Eight events (4 TIA, 4 strokes) occurred in the 59 patients with PFO alone, three (1 TIA, 2 strokes) in the 21 with PFO plus ASA and none in the 6 patients with ASA alone. In the overall population the cumulative risk of recurrent stroke/TIA was 1.2% at 2 years, 5.5% at 4 years, 7.6% at 6 years and 23.6% at 8 years, and was similar in patients with PFO alone vs. patients with PFO plus ASA (9.0% vs. 6.1% at 6 years, 26.0% vs. 23.1% at 8 years; p>0.05). Nine cerebral ischaemic events (4 TIA, 5 strokes) occurred in the 48 patients treated with antiplatelet drugs (7 in patients with PFO, 2 in patients with PFO plus ASA), and two (1 TIA, 1 stroke) in the 17 patients treated with oral anticoagulants (1 with PFO, 1 with PFO plus ASA). No events occurred in patients submitted to transcatheteral closure.
本研究旨在评估采用不同治疗方案治疗的卵圆孔未闭（PFO）或房间隔瘤（ASA）患者发生缺血性脑血管事件复发（中风或短暂性脑缺血发作（TIA））的风险。我们纳入了1994年5月至1999年12月期间转诊至我院住院部的86例年龄在18至60岁之间、患有不明原因缺血性中风或TIA的患者。随访持续至2003年4月。如果中风或TIA与大动脉粥样硬化、小动脉闭塞、主要心脏栓塞源或其他罕见原因有关，则将患者排除。在平均（标准差）为64.1（28.8）个月（范围8.1至105.6个月）的随访期间，86例患者中有11例（12.8%）发生了缺血性脑血管事件复发（5例TIA和6例中风）。仅患有PFO的59例患者中发生了8例事件（4例TIA，4例中风），PFO合并ASA的21例患者中有3例（1例TIA，2例中风），仅患有ASA的6例患者中无事件发生。在总体人群中，中风/TIA复发的累积风险在2年时为1.2%，4年时为5.5%，6年时为7.6%，8年时为23.6%，仅患有PFO的患者与PFO合并ASA的患者相似（6年时分别为9.0%和6.1%，8年时分别为26.0%和23.1%；p>0.05）。接受抗血小板药物治疗的48例患者中发生了9例脑缺血事件（4例TIA，5例中风）（PFO患者7例，PFO合并ASA患者2例），接受口服抗凝剂治疗的17例患者中有2例（1例TIA，1例中风）（1例PFO患者，1例PFO合并ASA患者）。接受经导管封堵的患者未发生事件。
