Weimar C, Holle D N, Benemann J, Schmid E, Schminke U, Haberl R L, Diener H-C, Goertler M
Department of Neurology, University of Duisburg-Essen, Essen, Germany.
Cerebrovasc Dis. 2009;28(4):349-56. doi: 10.1159/000229553. Epub 2009 Jul 24.
Right-to-left cardiac shunt (RLS) is considered a risk factor for stroke, especially in patients aged <55 years. We aimed to investigate the current management and prognosis in consecutive patients with RLS and otherwise cryptogenic cerebrovascular events.
In total, 1,126 patients with cryptogenic stroke or TIA were included from 17 German neurology departments. During a mean follow-up of 28.4 months, we assessed current antithrombotic medication, percutaneous device closure (PDC) and recurrent cerebrovascular events in 899 patients (79.8%). Stroke recurrence was compared between 548 patients without RLS and 351 patients with RLS under various prevention regimens.
RLS was detected in 35.9% of cryptogenic cerebrovascular patients, but could not be evaluated as an independent predictor for recurrent stroke (adjusted HR 1.6, 95% CI: 0.9-2.7). In RLS-positive patients, the Kaplan-Meier estimate for stroke during the first year was 4.1% (95% CI: 1.9-6.3%) and 1.7% (95% CI: 0.9-2.4%) per year thereafter. At the last follow-up before recurrent stroke or end of study, 117 RLS-positive patients (33.3%) had received a PDC, 154 (43.9%) were receiving antiplatelets, 63 (17.9%) received anticoagulation, and 17 (4.8%) received none of the above. No association with recurrent stroke was found for the secondary preventive regime.
Our multicenter hospital-based cohort study confirmed low recurrent event rates in RLS patients with otherwise cryptogenic stroke or TIA, as well as a great heterogeneity of current management. Despite the lack of scientific evidence, a substantial number of RLS-positive patients underwent PDC for secondary stroke prevention.
右向左心脏分流（RLS）被认为是中风的一个危险因素，尤其是在年龄小于55岁的患者中。我们旨在调查连续性RLS患者以及其他不明原因脑血管事件患者的当前治疗及预后情况。
从17个德国神经科纳入了总共1126例不明原因中风或短暂性脑缺血发作（TIA）患者。在平均28.4个月的随访期间，我们评估了899例患者（79.8%）当前的抗血栓药物治疗、经皮装置封堵（PDC）及复发性脑血管事件。比较了548例无RLS患者和351例有RLS患者在各种预防方案下的中风复发情况。
在35.9%的不明原因脑血管病患者中检测到RLS，但不能将其评估为复发性中风的独立预测因素（校正风险比1.6，95%置信区间：0.9 - 2.7）。在RLS阳性患者中，第一年中风的Kaplan-Meier估计值为4.1%（95%置信区间：1.9 - 6.3%），此后每年为1.7%（95%置信区间：0.9 - 2.4%）。在复发性中风或研究结束前的最后一次随访时，117例RLS阳性患者（33.3%）接受了PDC，154例（43.9%）接受抗血小板治疗，63例（17.9%）接受抗凝治疗，17例（4.8%）未接受上述任何治疗。未发现二级预防方案与复发性中风有关联。
我们基于多中心医院的队列研究证实，患有其他不明原因中风或TIA的RLS患者的复发事件率较低，以及当前治疗存在很大异质性。尽管缺乏科学证据，但大量RLS阳性患者接受了PDC用于二级中风预防。
