卵圆孔未闭与隐源性卒中的研究进展 Progress in Patent Foramen Ovale and Cryptogenic Stroke

Abstract

隐源性卒中约占所有缺血性卒中的40%，其病因、诊断和治疗一直是临床工作者的研究热点。近年来发现，卵圆孔未闭与隐源性卒中的发病密切相关，是隐源性卒中的重要危险因素。在临床中常用经食管超声心动图、经胸壁超声心动图、经颅多普勒发泡试验和心脏MRI等方法来检测卵圆孔未闭。反常栓塞是卵圆孔未闭导致隐源性卒中的主要发病机制。在头部影像学检查中，绝大多数卵圆孔未闭相关隐源性卒中患者为多血管分布区的多发散在小梗死。在药物治疗方面，抗血小板药物相对于抗凝药物，可能更适合大多数卵圆孔未闭合并隐源性卒中的患者。此外，近期多项临床随机对照研究均表明，卵圆孔未闭封堵术对于预防卵圆孔未闭合并隐源性卒中患者卒中再发的疗效明显优于药物治疗。 Cryptogenic stroke accounts for about 40% of all ischemic stroke. Its etiology, diagnosis and treatment have been the focus of clinical research. It has been found that patent foramen ovale (PFO) is closely related to cryptogenic stroke, and it is an important risk factor for cryptogenic stroke. PFO can be detected by transesophageal echocardiography, transthoracic echocardiography, transcranial Doppler foaming test and cardiac MRI. Paradoxical embolism is the main pathogenesis of occult stroke caused by PFO. The imaging features in most PFO-related cryptogenic stroke patients are multiple scattered small lesions in multiple vascular territories. Antiplatelet may be more suitable than anticoagulants therapy for most cryptogenic stroke patients with PFO. In addition, recent randomized controlled trials indicated that PFO closure was superior to drug therapy in preventing stroke recurrence in cryptogenic stroke patients with PFO.

Keywords

• 卵圆孔未闭
• 隐源性卒中
• 反常栓塞
• 治疗
• patent foramen ovale
• cryptogenic stroke
• paradoxical embolism
• treatment