Goldsweig Andrew M, Batlivala Sarosh P, Al-Azizi Karim, Aggarwal Vikas, Babatunde Ifeoluwa, Falck-Ytter Yngve, Morgan Rebecca L
Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
Heart Institute, Cincinnati Children's Hospital Medical Center & Division of Pediatric Cardiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
J Soc Cardiovasc Angiogr Interv. 2022 May 19;1(4):100040. doi: 10.1016/j.jscai.2022.100040. eCollection 2022 Jul-Aug.
Patent foramen ovale (PFO) is a common anatomic variant associated with intermittent right-to-left shunting. Transcatheter PFO closure has been proposed to address multiple clinical conditions including stroke, transient ischemic attack, migraine, and decompression illness.
A systematic review was conducted using the GRADE approach to address 5 questions formulated by the Society for Cardiovascular Angiography and Interventions (SCAI) Guideline Panel in patient, intervention, comparator, outcome (PICO) format. Medical literature from January 2015 through May 2021 was searched. Extracted data underwent review and risk-of-bias assessment by 2 independent researchers. Pooled effect estimates were calculated. Certainty of evidence was determined for each query.
Our search identified 2701 titles and abstracts, of which 30 met eligibility criteria and informed the technical review. Data were abstracted to address outcomes of PFO closure for patients with and without prior stroke, in comparison to antiplatelet therapy, in comparison to anticoagulation, and with various post-procedure antithrombotic regimens.
In appropriately selected patients with prior stroke, transcatheter PFO closure reduces the risk of recurrent stroke more than antiplatelet therapy alone. Evidence to support PFO closure is weaker regarding older patients, anticoagulation, thrombophilia, transient ischemic attack, migraine, and decompression illness. Data from this technical review will inform the SCAI Guideline for Transcatheter Patent Foramen Ovale Closure.
卵圆孔未闭（PFO）是一种常见的解剖变异，与间歇性右向左分流有关。经导管封堵卵圆孔未闭已被提议用于治疗多种临床疾病，包括中风、短暂性脑缺血发作、偏头痛和减压病。
采用GRADE方法进行系统评价，以解决心血管造影和介入学会（SCAI）指南小组以患者、干预措施、对照、结局（PICO）格式提出的5个问题。检索了2015年1月至2021年5月的医学文献。提取的数据由2名独立研究人员进行审查和偏倚风险评估。计算合并效应估计值。确定每个问题的证据确定性。
我们的检索识别出2701篇标题和摘要，其中30篇符合纳入标准并为技术审查提供了信息。提取数据以探讨卵圆孔未闭封堵术对有或无既往中风患者的结局，与抗血小板治疗相比，与抗凝治疗相比，以及与各种术后抗血栓治疗方案的比较。
在适当选择的既往有中风的患者中，经导管封堵卵圆孔未闭比单独使用抗血小板治疗更能降低复发性中风的风险。关于老年患者、抗凝治疗、血栓形成倾向、短暂性脑缺血发作、偏头痛和减压病，支持卵圆孔未闭封堵术的证据较弱。本次技术审查的数据将为SCAI经导管卵圆孔未闭封堵指南提供参考。
