Maloku Aurel, Hamadanchi Ali, Günther Albrecht, Aftanski Pawel, Schulze P Christian, Möbius-Winkler Sven
Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, 07747 Jena, Germany.
Department of Neurology, University Hospital Jena, 07747 Jena, Germany.
Rev Cardiovasc Med. 2024 Nov 22;25(11):422. doi: 10.31083/j.rcm2511422. eCollection 2024 Nov.
Current guidelines recommend closing a patent foramen ovale (PFO) in patients who have experienced a cryptogenic or cardioembolic stroke, have a high-risk PFO, and are aged between 16 and 60 years (class A recommendation, level I evidence). In terms of efficacy, in the CLOSE and RESPECT trials, the number needed-to-treat (NNT) to prevent one stroke recurrence in a five-year term was between 20 and 44. Other trials, such as the REDUCE trial, presented much better data with a NNT of 28 at two years and as low as 18 over a follow-up period of 10 years. Interventional PFO closure is relatively straightforward to learn compared to other cardiology procedures; however, it must be performed meticulously to minimize the risk of post-procedural complications. Usually, a double-disk occlusion device is used, followed by antiplatelet therapy. While the potential benefits of PFO closure for conditions such as migraines are currently being studied, robust trials are still required. Therefore, deciding to close a PFO for reasons other than stroke should be considered on a case-by-case basis.
目前的指南建议，对于发生过隐源性或心源性卒中、有高危卵圆孔未闭（PFO）且年龄在16至60岁之间的患者，应闭合PFO（A级推荐，I级证据）。在疗效方面，在CLOSE和RESPECT试验中，5年内预防一次卒中复发的需治疗人数（NNT）在20至44之间。其他试验，如REDUCE试验，提供了更好的数据，2年时NNT为28，10年随访期低至18。与其他心脏病学手术相比，介入性PFO闭合术相对容易掌握；然而，必须精心操作以将术后并发症风险降至最低。通常使用双盘封堵装置，随后进行抗血小板治疗。虽然目前正在研究PFO闭合术对偏头痛等病症的潜在益处，但仍需要有力的试验。因此，因卒中以外的原因决定闭合PFO应逐案考虑。
