Mas J L
Service de Neurologie, Centre R. Garcin, Hôpital Sainte-Anne, Paris.
Ann Cardiol Angeiol (Paris). 1996 Nov;45(9):531-7.
Persistence of a patent foramen ovale (PFO) and the presence of an aneurysm of the interatrial septum (AIAS) are significantly more frequent in patients examined for cerebral ischaemic accident of unknown cause than in control subjects. The mechanism of ischaemic accidents associated with these cardiac abnormalities (frequently associated with each other), particularly the frequency of paradoxical embolism, remains unclear. In young patients, the risk of recurrent cerebral ischaemic accident appears to be generally low (1 to 2% per year). Secondary prevention remains empirical and controversial. No comparative studies are available to demonstrate the superiority of platelet antiaggregants, oral anticoagulants or invasive treatments, such as endovascular or surgical closure of the foramen ovale. A rational treatment can only be proposed on the basis of a better understanding of the natural history of ischaemic recurrences (identification of subgroups of patients at high or low risk of recurrence) and the therapeutic benefit risk ratio.
在因不明原因的脑缺血性事故接受检查的患者中，卵圆孔未闭（PFO）的持续存在和房间隔瘤（AIAS）的存在明显比对照组更为常见。与这些心脏异常（两者经常同时出现）相关的缺血性事故机制，尤其是反常栓塞的发生率，仍不清楚。在年轻患者中，复发性脑缺血性事故的风险似乎总体较低（每年1%至2%）。二级预防仍然是经验性的且存在争议。尚无比较研究可证明血小板抗聚集剂、口服抗凝剂或侵入性治疗（如卵圆孔的血管内或手术闭合）的优越性。只有在更好地了解缺血复发的自然史（识别高复发风险或低复发风险的患者亚组）以及治疗效益风险比的基础上，才能提出合理的治疗方案。
