Parrini Iris, Cecchi Enrico, Forno Davide, Lyon Alexander R, Asteggiano Riccardo
Division of Cardiology, Mauriziano Hospital Turin, Italy.
Division of Cardiology, MariaVittoria Hospital Turin, Italy.
Eur Heart J Suppl. 2020 Dec 6;22(Suppl M):M43-M50. doi: 10.1093/eurheartj/suaa163. eCollection 2020 Nov.
Patent foramen ovale (PFO) and cryptogenic stroke (CS) both have a high prevalence. The optimal treatment to reduce stroke recurrence after CS remains controversial. Results from clinical trials, meta-analyses, and position papers, support percutaneous PFO device closure and medical therapy compared to medical therapy alone. However, the procedure may be associated with cardiac complications including an increased incidence of new atrial fibrillation. The benefit/risk balance should be determined on a case-by-case basis with the greatest benefit of PFO closure in patients with atrial septal aneurysm and PFO with large shunts. Future studies should address unsolved questions such as the choice of medical therapy in patients not undergoing closure, the duration of antiplatelet therapy, and the role of PFO closure in patients over 60 years old.
卵圆孔未闭（PFO）和隐源性卒中（CS）的患病率均较高。降低CS后卒中复发的最佳治疗方法仍存在争议。临床试验、荟萃分析和立场文件的结果支持，与单纯药物治疗相比，经皮PFO封堵术和药物治疗。然而，该手术可能与心脏并发症有关，包括新发房颤的发生率增加。应根据具体情况确定获益/风险平衡，对于患有房间隔瘤和有大量分流的PFO患者，PFO封堵术的获益最大。未来的研究应解决一些未解决的问题，如未接受封堵治疗患者的药物治疗选择、抗血小板治疗的持续时间，以及PFO封堵术在60岁以上患者中的作用。
