Department of Neurology, University of Toulouse, Toulouse, France.
Minerva Med. 2012 Jun;103(3):199-207.
Patent foramen ovale (PFO) is a common finding in healthy subjects and has not been associated with increased risk of ischemic stroke in population-based cohort studies. Nevertheless, case-control studies have consistently shown an increased prevalence of PFO in cryptogenic stroke, suggesting that PFO might be a cause of stroke. The risk of stroke recurrence in patients with cryptogenic stroke and PFO is low under aspirin therapy but may be substantially higher in patients with an associated atrial septal aneurysm (ASA). The mechanisms of stroke associated with PFO or ASA are uncertain. Paradoxical embolism through the PFO is rarely documented. The optimal treatment for secondary prevention in patients with cryptogenic stroke and PFO is still uncertain and debated. A randomized controlled trial failed to demonstrate the superiority of transcatheter PFO closure over medical therapy. Whether anticoagulation is superior to aspirin should be tested in a randomized controlled trial.
卵圆孔未闭（PFO）在健康人群中较为常见，且在基于人群的队列研究中与缺血性卒中风险增加无关。然而，病例对照研究一致显示，隐匿性卒中患者中 PFO 的发生率增加，表明 PFO 可能是卒中的一个病因。在接受阿司匹林治疗的隐匿性卒中伴 PFO 患者中，卒中复发的风险较低，但在伴有房间隔瘤（ASA）的患者中，风险可能显著增加。与 PFO 或 ASA 相关的卒中的发病机制尚不确定。通过 PFO 的反常栓塞很少有记录。对于隐匿性卒中伴 PFO 患者的二级预防，最佳治疗方法仍不确定，存在争议。一项随机对照试验未能证明经导管 PFO 封堵术优于药物治疗。抗凝是否优于阿司匹林，应在随机对照试验中进行检验。
