Department of Neurology, Radboud University Medical Centre, Donders institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Eur Stroke J. 2024 Mar;9(1):219-225. doi: 10.1177/23969873231214862. Epub 2023 Nov 18.
Patent foramen ovale (PFO) closure prevents recurrent ischemic stroke in selected patients with a cryptogenic stroke. Trial results tend to be generalized to daily practice, often extending original trial inclusion criteria. This may result in unnecessary closure without benefit, but with risk of complications. We therefore introduced a standardized and structured evaluation by an interdisciplinary Heart-Stroke Team (HST). Our aim was to investigate the proportion of actual PFO closure of all referred patients with a cryptogenic stroke, after evaluation by the HST.
We conducted a single-center, retrospective cohort study. Patients with an assumed cryptogenic ischemic stroke or transient ischemic attack (TIA) and a PFO who were referred for PFO closure were analyzed. As part of the HST approach, all patients underwent a standardized work-up, first to demonstrate the ischemic event on neuroimaging, second to evaluate all potential causes of stroke and finally, to assess the possible relation between the PFO and stroke. Outcome was the proportion of patients treated with PFO closure after referral.
A total of 195 patients were included. In 124 patients (64%) PFO closure was advised. Fourty-two (22%) patients had a clear alternative cause of stroke and in 13 (7%) patients the initial stroke diagnosis could not be confirmed.
After careful analysis of patients referred for PFO closure a relationship between the PFO and stroke could not be demonstrated in 32% of referrals, and 3% preferred best medical treatment over percutaneous closure. This stresses the need for a complete neurovascular work-up and multidisciplinary assessment.
卵圆孔未闭（PFO）封堵术可预防部分隐源性卒中患者的复发性缺血性卒中。试验结果往往被推广应用于日常实践中，常常扩展了原始试验的纳入标准。这可能导致不必要的封堵，没有获益，反而增加了并发症的风险。因此，我们引入了一个由多学科心脏-卒中团队（HST）进行的标准化和结构化评估。我们的目的是调查通过 HST 评估后，所有隐源性卒中患者中实际接受 PFO 封堵的比例。
我们进行了一项单中心回顾性队列研究。分析了假设的隐源性缺血性卒中或短暂性脑缺血发作（TIA）和 PFO 并被转诊行 PFO 封堵的患者。作为 HST 方法的一部分，所有患者都接受了标准化的检查，首先是在神经影像学上显示缺血事件，其次是评估所有潜在的卒中原因，最后是评估 PFO 与卒中之间的可能关系。结果是转诊后接受 PFO 封堵治疗的患者比例。
共纳入 195 例患者。在 124 例患者（64%）中建议行 PFO 封堵。42 例（22%）患者有明确的卒中替代病因，13 例（7%）患者最初的卒中诊断无法确认。
在仔细分析转诊行 PFO 封堵的患者后，32%的患者中无法证实 PFO 与卒中之间的关系，3%的患者首选最佳药物治疗而非经皮封堵。这强调了需要进行全面的神经血管检查和多学科评估。
