Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cardiology Division, Tallahassee Memorial Hospital, Southern Medical Group, Tallahassee, Florida.
JACC Cardiovasc Interv. 2020 Feb 10;13(3):293-302. doi: 10.1016/j.jcin.2019.09.042.
This study sought to evaluate the long-term effect of transcatheter patent foramen ovale (PFO) closure on migraineurs with and without aura and examine the effect of residual right-to-left shunt.
Many studies reported improvement in migraine symptoms after PFO closure, yet randomized trials failed to reach its clinical endpoints.
The study retrospectively analyzed data from 474 patients who underwent transcatheter PFO closure at Massachusetts General Hospital. Patients completed a migraine burden questionnaire at baseline and at follow-up. Migraine severity is reported as migraine frequency (days/month), average duration (min), and migraine burden (days × min/month). Improvement following closure was defined as complete abolishment of symptoms or >50% reduction in migraine burden.
A total of 110 migraineurs who underwent PFO closure were included; 77.0% had aura and 23.0% were without aura, and 91.0% had a cryptogenic stroke. During long-term median follow-up of 3.2 (interquartile range: 2.1 to 4.9) years, there was a significant improvement in migraine symptoms in migraineurs with or without aura. Migraine burden was reduced by >50% in 87.0% of patients, and symptoms were completely abolished in 48%. Presence of aura was associated with abolishment of migraine (odds ratio: 4.30; 95% confidence interval: 1.50 to 12.30; p = 0.006). At 6 months after PFO closure, residual right-to-left shunt was present in 26% of patients. Absence of right-to-left shunt was associated with improvement in migraine burden by >50% (odds ratio: 4.60; 95% confidence interval: 1.30 to 16.10; p = 0.017).
Long-term follow-up after transcatheter PFO closure was associated with significant improvement in migraine burden. Aura was a predictor of abolishing symptoms. Absence of residual right-to-left shunt was a predictor of significant reduction in migraine burden.
本研究旨在评估卵圆孔未闭（PFO）经导管封堵术对有先兆和无先兆偏头痛患者的长期疗效，并探讨残余右向左分流的影响。
许多研究报告称 PFO 封堵术后偏头痛症状有所改善，但随机试验未能达到其临床终点。
本研究回顾性分析了在马萨诸塞州综合医院接受经导管 PFO 封堵术的 474 例患者的数据。患者在基线和随访时完成偏头痛负担问卷。偏头痛严重程度以偏头痛发作频率（天/月）、平均持续时间（分钟）和偏头痛负担（天×分钟/月）来报告。封堵术后的改善定义为症状完全消除或偏头痛负担减少≥50%。
共纳入 110 例偏头痛患者，其中 77.0%有先兆，23.0%无先兆，91.0%有隐源性卒。在中位数为 3.2 年（四分位距：2.1 至 4.9 年）的长期随访中，有先兆和无先兆偏头痛患者的偏头痛症状均有显著改善。87.0%的患者偏头痛负担减少≥50%，48%的患者症状完全消除。有先兆与偏头痛消除相关（优势比：4.30；95%置信区间：1.50 至 12.30；p=0.006）。PFO 封堵术后 6 个月，26%的患者仍存在右向左分流。无右向左分流与偏头痛负担减少≥50%相关（优势比：4.60；95%置信区间：1.30 至 16.10；p=0.017）。
经导管 PFO 封堵术后的长期随访与偏头痛负担的显著改善相关。先兆是症状消除的预测因素。无残余右向左分流是偏头痛负担显著减少的预测因素。
