Centrum for Adults with Grown-Up Congenital Heart Disease (GUCH), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Centrum for Adults with Grown-Up Congenital Heart Disease (GUCH), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Region Vastra Gotaland, Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104860. doi: 10.1016/j.jstrokecerebrovasdis.2020.104860. Epub 2020 May 16.
Recent published trials have shown the efficacy of transcatheter closure of patent foramen ovale (PFO) for preventing recurrent cryptogenic cerebrovascular events. However, the risk of recurrent cerebrovascular events (rCVEs) is up to 5.7%, and the etiology is unclear.
This study aimed to investigate the risk factors for rCVEs after closure of PFO during long-term follow-up.
In our center, 282 consecutive patients underwent PFO closure because of a cryptogenic cerebrovascular event between 2006 and 2014. Their Risk of Paradoxical Embolism (RoPE) score was calculated retrospectively. We followed up with the patients by telephone, using hospital records to identify those who suffered from rCVEs. Patients with rCVEs were matched with two control patients of the same sex and RoPE score without rCVEs who underwent PFO closure at approximately the same time. The patients with rCVEs and controls participated in a clinical examination, including contrast transthoracic echocardiography (TTE) and Holter electrocardiography, to investigate the possible cause of rCVEs compared with controls.
Fourteen (5%) out of the 282 consecutive patients who underwent PFO closure suffered from rCVEs during a mean follow-up of 8.4 years (1.7 rCVEs per 100 patient-years). The median RoPE score of the patients was 7. Recurrent CVE occurred in 3.2 patients per 100 patient-years in patients with residual shunting compared with 0.8 patients per 100 patient-years in those without residual shunt. These patients were on antiplatelet treatment or without any effective anticoagulant treatment at the time rCVE occurred. The risk ratio of rCVEs in patients with residual shunting was 2.9-times higher than in patients without residual shunting (95% CI: 1.4-6.1) at follow-up visit. Four patients who had the BioSTAR device implanted suffered from an rCVE despite lack of residual shunting.
This study indicates that residual shunting and choice of the device may be the major reasons for rCVEs.
最近发表的试验表明，卵圆孔未闭（PFO）经导管封堵术预防复发性隐源性脑血管事件的疗效。然而，复发性脑血管事件（rCVE）的风险高达 5.7%，其病因尚不清楚。
本研究旨在探讨长期随访中 PFO 封堵后 rCVE 的危险因素。
在我们中心，2006 年至 2014 年间，因隐源性脑血管事件连续 282 例患者接受 PFO 封堵。回顾性计算他们的矛盾栓塞风险（RoPE）评分。我们通过电话对患者进行随访，利用医院记录确定发生 rCVE 的患者。将 rCVE 患者与同期接受 PFO 封堵且无 rCVE 的 2 名相同性别和 RoPE 评分的对照患者进行匹配。rCVE 患者和对照组患者接受临床检查，包括对比经胸超声心动图（TTE）和动态心电图检查，以调查与对照组相比 rCVE 的可能原因。
282 例连续接受 PFO 封堵的患者中，14 例（5%）在平均 8.4 年的随访中发生 rCVE（每 100 例患者中有 1.7 例 rCVE）。患者的中位 RoPE 评分为 7。与无残余分流的患者相比，残余分流患者的 rCVE 发生率为每 100 例患者每年 3.2 例，而无残余分流的患者为每 100 例患者每年 0.8 例。这些患者在 rCVE 发生时正在接受抗血小板治疗或没有任何有效的抗凝治疗。随访时，有残余分流的患者 rCVE 的风险比为无残余分流的患者高 2.9 倍（95%CI：1.4-6.1）。尽管没有残余分流，但 4 名植入 BioSTAR 装置的患者发生了 rCVE。
本研究表明，残余分流和装置的选择可能是 rCVE 的主要原因。
