Belopasova A V, Kulesh A A, Mekhryakov S A, Chazov S A, Syromyatnikova L I, Chechetkin A O, Karshieva A R, Kadykov A S
Research Center of Neurology, Moscow, Russia.
Vagner State Medical University, Perm, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(3. Vyp. 2):13-19. doi: 10.17116/jnevro202312303213.
To analyze clinical and instrumental characteristics of patients with ischemic stroke (IS) due to paradoxical embolism according to the data of hospital registers of Moscow and Perm.
A comprehensive study of 114 patients, aged 18 to 55 years, with IS by the mechanism of paradoxical embolism was carried out. All patients underwent clarification of the cause of IS (electrocardiography, ultrasound scanning of the brachiocephalic arteries, CT or MRI of the brain, CT or MR angiography, transthoracic and/or transesophageal echocardiography). The presence of right-left shunt blood flow (RLS) was confirmed by transcranial dopplerography with a bubble test. The clinical significance of patent foramen ovale (PFO) was assessed according to The PFO-Associated Stroke Causal Likelihood Classification System (PASCAL).
Clinical and instrumental characteristics of patients with IS due to paradoxical embolism were obtained from two hospital registries. In both groups, the leading trigger for the development of IS was the Valsalva phenomen (>20%), the share of other provoking factors did not exceed 10%. Significant differences between the analyzed groups related to the ultrasonic characteristics of RLS/PFO: patients with a grade 4 shunt predominated in the Research Center of Neurology (RCN) population, while patients with a grade 3 shunt predominated in the City Clinical Hospital (CCH) №4 group. At the same time, there were twice as many patients with aneurysm of the interatrial septum in the CCH №4 group. In accordance with the PASCAL classification, in 93% of RCN patients, PFO can be considered as a probable cause of IS, while in the CCH No. 4 group, a probable causal relationship was traced only in 51% of cases, in 18% of patients, the role of an anomaly in the development of stroke was unlikely.
The analysis showed that the primary screening of RLS in a regional vascular center allows classifying PFO as a probable cause of IS in only half of the patients. For a more accurate selection of patients for whom endovascular occlusion of the PFO will be most effective, an in-depth examination in a specialized hospital is recommended.
根据莫斯科和彼尔姆医院登记的数据，分析反常栓塞所致缺血性卒中（IS）患者的临床和影像学特征。
对114例年龄在18至55岁之间、因反常栓塞机制导致IS的患者进行了全面研究。所有患者均明确了IS的病因（心电图、头臂动脉超声扫描、脑部CT或MRI、CT或MR血管造影、经胸和/或经食管超声心动图）。通过经颅多普勒气泡试验证实了左右分流血流（RLS）的存在。根据卵圆孔未闭（PFO）相关卒中因果可能性分类系统（PASCAL）评估PFO的临床意义。
从两个医院登记处获得了反常栓塞所致IS患者的临床和影像学特征。在两组中，IS发生的主要诱因是瓦尔萨尔瓦动作（>20%），其他诱发因素的比例不超过10%。分析组之间与RLS/PFO的超声特征相关的显著差异：神经学研究中心（RCN）人群中以4级分流患者为主，而市立临床医院（CCH）第4组中以3级分流患者为主。同时，CCH第4组中房间隔瘤患者的数量是RCN组的两倍。根据PASCAL分类，在93%的RCN患者中，PFO可被视为IS的可能病因，而在CCH第4组中，仅在51%的病例中发现可能的因果关系，在18%的患者中，异常在卒中发生中的作用不太可能。
分析表明，在区域血管中心对RLS进行初步筛查仅能将PFO归类为半数患者IS的可能病因。为了更准确地选择PFO血管内封堵最有效的患者，建议在专科医院进行深入检查。
