Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
Hans-Berger-Department of Neurology, University Hospital Jena, Jena, Germany.
Herz. 2021 Oct;46(5):445-451. doi: 10.1007/s00059-021-05061-y. Epub 2021 Aug 31.
Closure of a patent foramen ovale (PFO) in patients after cryptogenic/cardioembolic stroke is recommended by current guidelines for patients who are 16-60 years of age with a high-risk PFO (class of recommendation A, level of evidence I). The use of double-disk occlusion devices followed by antiplatelet therapy is recommended. The procedure of interventional PFO closure compared with other interventions in cardiology is rather easy to learn. However, it should be performed carefully to avoid postinterventional complications. The number needed to treat (NNT) to avoid one stroke in 5 years in the RESPECT trial was 42, in the CLOSE trial even lower with 20. In the REDUCE trial, the NNT was 28 at 2 years. This can be reduced by longer follow-up, e.g., at 10 years the NNT is 18. While other conditions such as migraine are currently under investigation with respect to the impact of PFO closure, sufficiently powered trials are lacking so that closure in diseases other than stroke should always be individualized.
卵圆孔未闭 (PFO) 封堵术适用于年龄在 16-60 岁之间、存在高危 PFO（推荐级别 A，证据水平 I）的隐源性/心源性卒中患者。推荐使用双盘封堵装置联合抗血小板治疗。与心脏病学中的其他介入治疗方法相比，经皮卵圆孔未闭封堵术的操作相对简单，但仍需仔细操作以避免术后并发症。在 RESPECT 试验中，5 年内避免 1 次卒中的治疗人数（NNT）为 42，CLOSE 试验中甚至更低，为 20。在 REDUCE 试验中，2 年的 NNT 为 28。通过延长随访时间（例如，10 年时的 NNT 为 18），可以降低 NNT。目前，对于偏头痛等其他疾病对 PFO 封堵的影响正在进行研究，但缺乏足够大的试验，因此除了卒中之外的其他疾病的 PFO 封堵应始终个体化。
