Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology, Schulich School of Medicine and Dentistry (L.A.S.), Western University, London, ON, Canada.
Heart & Brain Laboratory (L.A.S.), Western University, London, ON, Canada.
Stroke. 2024 Jan;55(1):236-247. doi: 10.1161/STROKEAHA.123.040546. Epub 2023 Nov 21.
Patent foramen ovale (PFO) is frequently identified in young patients with ischemic stroke. Randomized controlled trials provide robust evidence supporting PFO closure in selected patients with cryptogenic ischemic stroke; however, several questions remain unanswered. This report summarizes current knowledge on the epidemiology of PFO-associated stroke, the role of PFO as a cause of stroke, and anatomic high-risk features. We also comment on breakthrough developments in patient selection algorithms for PFO closure in relation to the PFO-associated stroke causal likelihood risk stratification system. We further highlight areas for future research in PFO-associated stroke including the efficacy and safety of PFO closure in the elderly population, incidence, and long-term consequences of atrial fibrillation post-PFO closure, generalizability of the results of clinical trials in the real world, and the need for assessing the effect of neurocardiology teams on adherence to international recommendations. Other important knowledge gaps such as sex, race/ethnicity, and regional disparities in access to diagnostic technologies, PFO closure devices, and clinical outcomes in the real world are also discussed as priority research topics.
卵圆孔未闭（PFO）在缺血性卒中的年轻患者中经常被发现。随机对照试验为 PFO 封堵术在某些隐源性缺血性卒中患者中的应用提供了强有力的证据；然而，仍有几个问题尚未得到解答。本报告总结了 PFO 相关卒中的流行病学、PFO 在卒中中的作用以及解剖学高危特征的最新知识。我们还就 PFO 封堵术患者选择算法的突破进展进行了评论，这些进展与 PFO 相关卒中因果可能性分层系统有关。我们还进一步强调了 PFO 相关卒中的未来研究领域，包括 PFO 封堵术在老年人群中的疗效和安全性、PFO 封堵术后心房颤动的发生率和长期后果、临床试验结果在真实世界中的可推广性，以及评估神经心脏病团队对国际建议的依从性的必要性。其他重要的知识空白，如性别、种族/民族以及在真实世界中获得诊断技术、PFO 封堵装置和临床结局的机会方面的差异，也被列为优先研究课题。
