Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville.
Comprehensive Stroke Center, David Geffen School of Medicine, Department of Neurology, University of California, Los Angeles, Los Angeles.
JAMA Neurol. 2020 Jul 1;77(7):878-886. doi: 10.1001/jamaneurol.2020.0458.
Recent epidemiologic and therapeutic advances have transformed understanding of the role of and therapeutic approach to patent foramen ovale (PFO) in ischemic stroke. Patent foramen ovale is likely responsible for approximately 5% of all ischemic strokes and 10% of those occurring in young and middle-aged adults.
Randomized clinical trials have demonstrated that, to prevent recurrent ischemic stroke in patients with PFO and an otherwise-cryptogenic index ischemic stroke, PFO closure is superior to antiplatelet medical therapy alone; these trials have provided some evidence that, among medical therapy options, anticoagulants may be more effective than antiplatelet agents.
These new data indicate a need to update classification schemes of causative mechanisms in stroke, developed in an era in which an association between PFO and stroke was viewed as uncertain. We propose a revised general nomenclature and classification framework for PFO-associated stroke and detailed revisions for the 3 major stroke subtyping algorithms in wide use.
最近的流行病学和治疗进展改变了对卵圆孔未闭（PFO）在缺血性卒中中的作用和治疗方法的理解。PFO 可能导致大约 5%的所有缺血性卒中和 10%的中青年缺血性卒中。
随机临床试验表明，为了预防 PFO 合并其他隐匿性缺血性卒中患者的复发性缺血性卒中，PFO 封堵优于单独抗血小板药物治疗；这些试验提供了一些证据表明，在药物治疗选择中，抗凝剂可能比抗血小板药物更有效。
这些新数据表明，需要更新在 PFO 与卒中之间的关联被视为不确定的时代制定的卒中病因机制分类方案。我们提出了一个改良的 PFO 相关卒中的通用命名法和分类框架，并对广泛使用的 3 种主要卒中亚型算法进行了详细修订。
