Mas Jean-Louis
Service de neurologie, hôpital Sainte-Anne, Paris. Université de Paris, Inserm 1266, Paris, France.
Rev Prat. 2021 Feb;71(2):177-181.
"Patent foramen ovale and stroke Patent foramen ovale (PFO) is a remnant of the fetal circulation whose role in the occurrence of ischemic stroke is now well established. Trancatheter PFO closure followed by long-term antiplatelet therapy reduces by approximately 60% compared to antithrombotic therapy alone, the risk of stroke recurrence in patients aged 60 years or less with an ischemic stroke attributed to a PFO. Patients with PFO associated with an atrial septal aneurysm or with a large right-to-left shunt might be the best candidates. The superiority of oral anticoagulants over aspirin is uncertain. Their benefit compared to PFO closure is unknown. Other studies are needed to: (i) precisely define the patients who benefit the most, little or not at all from PFO closure, (ii) assess the long-term prognosis of atrial fibrillation induced by PFO closure, (iii) evaluate the benefit of the closure in patients not included in the therapeutic trials, in particular patients over the age of 60, (iv) evaluate the role of oral anticoagulants compared to aspirin and to PFO closure."
卵圆孔未闭与中风 卵圆孔未闭（PFO）是胎儿循环的遗迹，其在缺血性中风发生中的作用现已得到充分证实。与单独的抗栓治疗相比，经导管封堵卵圆孔未闭并长期使用抗血小板治疗可使60岁及以下因卵圆孔未闭导致缺血性中风的患者中风复发风险降低约60%。伴有房间隔瘤或大量右向左分流的卵圆孔未闭患者可能是最佳候选者。口服抗凝剂相对于阿司匹林的优势尚不确定。与卵圆孔未闭封堵相比，其益处尚不清楚。需要进行其他研究以：（i）精确界定从卵圆孔未闭封堵中获益最大、获益少或根本无获益的患者；（ii）评估卵圆孔未闭封堵引起的心房颤动的长期预后；（iii）评估未纳入治疗试验的患者（特别是60岁以上患者）封堵的益处；（iv）评估口服抗凝剂相对于阿司匹林和卵圆孔未闭封堵的作用。
