Lee Oh-Hyun, Kim Jung-Sun
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea.
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean Circ J. 2022 Nov;52(11):801-807. doi: 10.4070/kcj.2022.0258.
Percutaneous patent foramen ovale (PFO) closure in patients with a prior PFO-associated stroke showed a risk reduction of the stroke recurrence compared to the medical therapy alone in recent several studies. Nevertheless, optimal patient selection for PFO closure has not been clarified. In this paper, we discuss the characteristics of PFO-associated strokes and discuss the recently published evidence and patient selection for PFO closure in patients with ischemic stroke. The lesions characteristics of PFO-associated stroke are associated with multiple scattered lesion, small sized cerebral cortical lesion, or posterior circulation. Overcoming the failure of early studies in CLOSURE I, PC, and RESPECT trials, PFO closure showed a significant reduction in recurrent stroke in recently published REDUCE, CLOSE, DEFENSE-PRO trials, and long-term follow-up data of RESPECT study. However, considering that PFO closure cannot completely prevent stroke recurrence and that complications including atrial fibrillation, we should be selectively performed in patients with high-risk PFO.
在最近的几项研究中，与单纯药物治疗相比，对既往有卵圆孔未闭（PFO）相关卒中的患者进行经皮PFO封堵术可降低卒中复发风险。然而，PFO封堵术的最佳患者选择尚未明确。在本文中，我们讨论PFO相关卒中的特征，并探讨最近发表的关于缺血性卒中患者PFO封堵术的证据和患者选择。PFO相关卒中的病灶特征与多个散在病灶、小尺寸脑皮质病灶或后循环有关。克服了早期CLOSURE I、PC和RESPECT试验的失败，PFO封堵术在最近发表的REDUCE、CLOSE、DEFENSE-PRO试验以及RESPECT研究的长期随访数据中显示复发性卒中显著减少。然而，考虑到PFO封堵术不能完全预防卒中复发且存在包括心房颤动在内的并发症，应在高危PFO患者中选择性地进行该手术。
