Borończyk Michał, Michalewska-Włudarczyk Aleksandra, Woźniak Julia, Kardas Natalia, Mąka Magdalena, Skorgowski Nikita, Rost Daria, Marks Marta, Smolka Grzegorz, Puz Przemysław, Krzan-Bosaczyk Aleksandra, Smolarek-Nicpoń Malwina, Wojakowski Wojciech, Lasek-Bal Anetta
Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.
Department of Neurology, Upper-Silesian Medical Center of the Medical University of Silesia, Katowice, Poland.
Kardiol Pol. 2025 Jul 11. doi: 10.33963/v.phj.107191.
Nearly half of all patients with cryptogenic stroke (CS) have a patent foramen ovale (PFO). Percutaneous PFO closure is a well-established method for secondary prevention of CS and should be considered for individuals with the highest likelihood of a causal link between PFO and stroke.
The study aimed to describe the qualification process and analyze the profiles of patients eligible for PFO closure as a secondary prevention strategy for CS.
This study involved a retrospective review of the medical records of patients who were assessed for PFO closure by the NeuroHeart Team. A total of 276 patients were included in the study. Of these, 132 patients (47.8%) were found to be eligible for PFO closure. Key determinants of patient eligibility for the procedure were identified based on a range of demographic, clinical, neuroimaging, and echocardiographic factors.
Qualified patients were less likely to be female (52.3% vs. 77.1%; P <0.001), had a higher incidence of acute cerebral ischemia - stroke or transient ischemic attack (P <0.001), were more frequently hospitalized for stroke/transient ischemic attack (82.6% vs. 29.9%; P <0.001), and were less likely to have non-ischemic central nervous system changes (12.9% vs. 50%; P <0.001). Additionally, qualified patients had lower comorbidity as expressed in Charlson's Comorbidity Index and achieved higher scores on the Risk of Paradoxical Embolism scale.
During the qualification process for PFO closure, a patient's clinical profile should be thoroughly assessed, with careful consideration of the procedure's benefits and risks in line with current recommendations from scientific societies.
近一半的隐源性卒中（CS）患者存在卵圆孔未闭（PFO）。经皮PFO封堵术是CS二级预防的成熟方法，对于PFO与卒中之间因果关系可能性最高的个体应予以考虑。
本研究旨在描述资格认定过程，并分析符合PFO封堵术作为CS二级预防策略的患者特征。
本研究对神经心脏团队评估PFO封堵术的患者病历进行回顾性分析。共纳入276例患者。其中，132例患者（47.8%）被认定符合PFO封堵术条件。根据一系列人口统计学、临床、神经影像学和超声心动图因素确定患者符合该手术的关键决定因素。
符合条件的患者女性比例较低（52.3%对77.1%；P<0.001），急性脑缺血（卒中或短暂性脑缺血发作）发生率较高（P<0.001），因卒中/短暂性脑缺血发作住院的频率更高（82.6%对29.9%；P<0.001），发生非缺血性中枢神经系统改变的可能性较小（12.9%对50%；P<0.001）。此外，符合条件的患者按照Charlson合并症指数计算的合并症较少，在反常栓塞风险量表上得分较高。
在PFO封堵术资格认定过程中，应全面评估患者的临床特征，并根据科学学会的当前建议仔细考虑该手术的益处和风险。
