Vidal-Calés Pablo, Llull Laura, Lanthier Sylvain, Del Portillo Juan H, Desjardins Laurent, Houde Christine, Sirois Pierre-Olivier, Freixa Xavier, Chamorro Ángel, Rodés-Cabau Josep
Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Department of Neuroscience, Hospital Clínic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
Struct Heart. 2025 Jul 9;9(8):100699. doi: 10.1016/j.shj.2025.100699. eCollection 2025 Aug.
Stroke is a major cause of morbidity and mortality worldwide, with recurrence risk increasing with age. In patients over 60 years of age with cryptogenic stroke, paradoxical embolism through a patent foramen ovale may be an important pathophysiology contributor, particularly when high-risk anatomical features (e.g., large shunt, atrial septal aneurysm) are present. Although patent foramen ovale closure has become a standard therapy in younger cryptogenic stroke patients, its benefit in older adults remains uncertain due to limited evidence and the need to exclude highly prevalent alternative causes like atrial fibrillation or carotid disease. A multidisciplinary heart-brain team is critical for accurate diagnosis, patient selection, and shared decision-making. Current guidelines vary and highlight the need for more robust data in this population. Recent observational studies suggest that patent foramen ovale closure in older patients may be safe and potentially reduce stroke recurrence compared to antithrombotic therapy alone. Ongoing randomized controlled trials are expected to provide definitive evidence on the efficacy and safety of patent foramen ovale closure in this age group, guiding future clinical decisions.
中风是全球发病和死亡的主要原因，复发风险随年龄增长而增加。在60岁以上的隐源性中风患者中，通过卵圆孔未闭的反常栓塞可能是一个重要的病理生理因素，特别是当存在高风险解剖特征（如大分流、房间隔瘤）时。尽管卵圆孔未闭封堵术已成为年轻隐源性中风患者的标准治疗方法，但由于证据有限且需要排除房颤或颈动脉疾病等高度常见的其他病因，其在老年人中的益处仍不确定。多学科心脑团队对于准确诊断、患者选择和共同决策至关重要。目前的指南各不相同，强调需要在这一人群中获得更有力的数据。最近的观察性研究表明，与单独抗栓治疗相比，老年患者的卵圆孔未闭封堵术可能是安全的，并有可能降低中风复发率。正在进行的随机对照试验有望为该年龄组卵圆孔未闭封堵术的疗效和安全性提供确凿证据，指导未来的临床决策。
