Serena J, Jiménez-Nieto M, Silva Y, Castellanos M
Department of Neurology and Stroke Research Unit. Institut d'Investigaciò Biomèdica de Girona, Spain.
Curr Cardiol Rev. 2010 Aug;6(3):162-74. doi: 10.2174/157340310791658794.
Recent studies support the hypothesis of a close aetiological and pathogenic association between the presence of patent foramen ovale (PFO) and cryptogenic stroke. The therapeutic options currently used in the treatment of these patients range from standard antiaggregation and standard-dose anticoagulation to the percutaneous occlusion of the PFO. The use or recommendation of treatment is based both on clinical risk factors associated with PFO, such as age, detection of states of hypercoagulability and previous history of stroke, and on the risks associated to right-to-left shunt (RLSh) and PFO, such as the size of PFO, magnitude of RLSh and the presence of atrial septal aneurysm (ASA). However, there is currently no consensus regarding the most suitable treatment and it is surprising to observe the widespread use of certain therapeutic approaches which are not supported by clinical evidence. In this revision, we analyse the relevance of PFO in cryptogenic stroke, consider the main evidence available for determining the best management of these patients and make diagnostic and therapeutic management recommendations.
近期研究支持卵圆孔未闭（PFO）与不明原因卒中之间存在密切病因学和病理学关联的假说。目前用于治疗这些患者的治疗选择范围从标准抗聚集和标准剂量抗凝到PFO的经皮封堵。治疗的使用或推荐既基于与PFO相关的临床风险因素，如年龄、高凝状态检测和既往卒中史，也基于与右向左分流（RLSh）和PFO相关的风险，如PFO大小、RLSh程度和房间隔瘤（ASA）的存在。然而，目前对于最合适的治疗尚无共识，并且令人惊讶的是，观察到某些未得到临床证据支持的治疗方法被广泛使用。在本综述中，我们分析了PFO在不明原因卒中中的相关性，考虑了可用于确定这些患者最佳管理的主要证据，并提出了诊断和治疗管理建议。
