Rigatelli Gianluca, Dell'avvocata Fabio, Cardaioli Paolo, Giordan Massimo, Braggion Gabriele, Aggio Silvio, L'erario Roberto, Chinaglia Mauro
Am J Cardiovasc Dis. 2012;2(2):89-95. Epub 2012 May 20.
We sought to assess the long-term faith of migraine in patients with high risk anatomic and functional characteristics predisposing to paradoxical embolism submitted to patent foramen ovale (PFO) transcatheter closure.
In a prospective single-center non randomized registry from January 2004 to January 2010 we enrolled 80 patients (58 female, mean age 42±2.7 years, 63 patients with aura) submitted to transcatheter PFO closure in our center. All patients fulfilled the following criteria: basal shunt and shower/curtain shunt pattern on transcranial Doppler and echocardiography, presence of interatrial septal aneurysm (ISA) and Eustachian valve, 3-4 class MIDAS score, coagulation abnormalities, medication-refractory migraine with or without aura. Migraine Disability Assessment Score (MIDAS) was used to assess the incidence and severity of migraine before and after mechanical closure. High risk features for paradoxical embolism included all of the following.
Percutaneous closure was successful in all cases (occlusion rate 91.2%), using a specifically anatomically-driven tailored strategy, with no peri-procedural or in-hospital complications; 70/80 of patients (87.5%) reported improved migraine symptomatology (mean MIDAS score decreased 33.4±6.7 to 10.6±9.8, p<0.03) whereas 12.5% reported no amelioration: none of the patients reported worsening of the previous migraine symptoms. Auras were definitively cured in 61/63 patients with migraine with aura (96.8%).
Transcatheter PFO closure in a selected population of patients with severe migraine at high risk of paradoxical embolism resulted in a significant reduction in migraine over a long-term follow-up.
我们试图评估在具有解剖和功能高风险特征、易发生反常栓塞的卵圆孔未闭（PFO）患者中，经导管封堵PFO后偏头痛的长期转归。
在2004年1月至2010年1月的一项前瞻性单中心非随机注册研究中，我们纳入了80例在本中心接受经导管PFO封堵的患者（58例女性，平均年龄42±2.7岁，63例有先兆）。所有患者均符合以下标准：经颅多普勒和超声心动图显示基础分流及雨帘样分流模式、存在房间隔瘤（ISA）和欧氏瓣、MIDAS评分3 - 4级、凝血异常、药物难治性偏头痛（有或无先兆）。采用偏头痛残疾评估量表（MIDAS）评估机械封堵前后偏头痛的发生率和严重程度。反常栓塞的高风险特征包括以下所有情况。
采用专门根据解剖结构定制的策略，所有病例经皮封堵均成功（封堵率91.2%），无围手术期或住院期间并发症；70/80例患者（87.5%）报告偏头痛症状改善（平均MIDAS评分从33.4±6.7降至10.6±9.8，p<0.03），而12.5%的患者报告无改善：无患者报告先前偏头痛症状恶化。61/63例有先兆偏头痛患者的先兆症状得到彻底治愈（96.8%）。
在有反常栓塞高风险的重度偏头痛患者特定人群中，经导管PFO封堵在长期随访中导致偏头痛显著减轻。
