From the Department of Neurology (S.R.M., S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (G.S.G., L.R.), University of Kansas Medical Center, MO; Institute for Clinical Research and Health Policy Studies (D.M.K.), Tufts University School of Medicine, Boston, MA; Cardiology Section (J.R.K.), San Francisco Veterans Affairs Health Care System, and Departments of Medicine, and Epidemiology and Biostatistics (J.R.K.), University of California San Francisco; Division of Cardiology (S.H.), Columbia University Medical Center, New York; Department of Medicine (Cardiology) (J.D.C.), University of Colorado School of Medicine, Aurora; Department of Neurology (K.I.), New York University; and Department of Neurology (N.S.), Kaiser Permanente, Los Angeles, CA.
Neurology. 2020 May 19;94(20):876-885. doi: 10.1212/WNL.0000000000009443. Epub 2020 Apr 29.
To update the 2016 American Academy of Neurology (AAN) practice advisory for patients with stroke and patent foramen ovale (PFO).
The guideline panel followed the AAN 2017 guideline development process to systematically review studies published through December 2017 and formulate recommendations.
In patients being considered for PFO closure, clinicians should ensure that an appropriately thorough evaluation has been performed to rule out alternative mechanisms of stroke (level B). In patients with a higher risk alternative mechanism of stroke identified, clinicians should not routinely recommend PFO closure (level B). Clinicians should counsel patients that having a PFO is common; that it occurs in about 1 in 4 adults in the general population; that it is difficult to determine with certainty whether their PFO caused their stroke; and that PFO closure probably reduces recurrent stroke risk in select patients (level B). In patients younger than 60 years with a PFO and embolic-appearing infarct and no other mechanism of stroke identified, clinicians may recommend closure following a discussion of potential benefits (absolute recurrent stroke risk reduction of 3.4% at 5 years) and risks (periprocedural complication rate of 3.9% and increased absolute rate of non-periprocedural atrial fibrillation of 0.33% per year) (level C). In patients who opt to receive medical therapy alone without PFO closure, clinicians may recommend an antiplatelet medication such as aspirin or anticoagulation (level C).
更新 2016 年美国神经病学学会（AAN）针对伴有卵圆孔未闭（PFO）的中风患者的实践指南。
指南小组遵循 AAN 2017 年指南制定流程，系统地回顾了截至 2017 年 12 月发表的研究，并制定了建议。
在考虑对 PFO 进行封堵的患者中，临床医生应确保进行了适当彻底的评估，以排除中风的其他替代机制（B 级）。在确定存在更高风险的替代中风机制的患者中，临床医生不应常规推荐 PFO 封堵（B 级）。临床医生应告知患者，PFO 较为常见；在一般人群中，约有 1/4 的成年人存在 PFO；很难确定其 PFO 是否导致了中风；PFO 封堵可能会降低某些患者的复发性中风风险（B 级）。对于年龄小于 60 岁且存在 PFO 及栓塞样梗死但未发现其他中风机制的患者，在讨论潜在获益（5 年内复发性中风风险绝对降低 3.4%）和风险（围手术期并发症发生率为 3.9%，非围手术期心房颤动的绝对发生率每年增加 0.33%）后，临床医生可以建议进行封堵（C 级）。对于选择不进行 PFO 封堵而仅接受药物治疗的患者，临床医生可以建议使用抗血小板药物（如阿司匹林）或抗凝治疗（C 级）。
