国家神经系统疾病临床医学研究中心数据管理与共享系统

发表杂志：Lancet Neurology

发表类型: Review

影响因子(IF): 44.182

PMID: 29262997 Pubmed原文链接 全文下载

Beginning with a clinical highlight: three randomised trials1, 2, 3 that tested the safety and efficacy of patent foramen ovale (PFO) closure after a cryptogenic stroke reported their results simultaneously. The CLOSE trial1 enrolled patients who had a recent PFO-attributed stroke associated with either an atrial septal aneurysm or a large, right-to-left interatrial shunt. Compared with antiplatelet therapy alone, a lower rate of recurrent stroke was reported after combined PFO closure and antiplatelet therapy (hazard ratio [HR] 0·03, 95% CI 0·00–0·26; p=0·001), to the extent that would, statistically, result in one stroke avoided at 5 years per 20 patients treated with PFO closure-treated. However, PFO closure was also associated with an increased risk of atrial fibrillation (4·6% vs 0·9%, p=0·02). The Gore REDUCE trial2 similarly showed that the risks of new and recurrent stroke were significantly lower with PFO closure combined with antiplatelet therapy than with antiplatelet therapy alone (1·4% vs 5·4%; HR 0·23, 95% CI 0·09–0·62; p=0·002 for recurrent stroke; 5·7% vs 11·3%; relative risk [RR] 0·51, 0·29–0·91; p=0·04 for new stroke). PFO closure was also associated with complications related to devices (1·4%) and, as in the CLOSE trial, with atrial fibrillation (6·6% vs 0·4%, p=0·001). The RESPECT trial3 reported the results of long-term follow up after PFO closure (mean 5·9 years), showing that PFO closure combined with anticoagulant pharmacotherapy was associated with a lower rate of recurrent stroke than pharmacotherapy alone (HR 0·55, 95% CI 0·31–0·999; p=0·046).