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  • 姜乐,沈红健,沈芳,张萍,吴涛,邓本强*.隐源性脑卒中合并卵圆孔未闭患者的临床特点分析[J].第二军医大学学报,2018,39(9):1061-封三    [点击复制]
  • JIANG Yue,SHEN Hong-jian,SHEN Fang,ZHANG Ping,WU Tao,DENG Ben-qiang*.Clinical characteristics of patients with cryptogenic stroke and patent foramen ovale[J].Acad J Sec Mil Med Univ,2018,39(9):1061-封三   [点击复制]
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隐源性脑卒中合并卵圆孔未闭患者的临床特点分析
姜乐,沈红健,沈芳,张萍,吴涛,邓本强*
0
(海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433
*通信作者)
摘要:
目的 探讨隐源性脑卒中合并卵圆孔未闭(PFO)患者的临床特点。方法 回顾性分析2013年9月至2018年1月在海军军医大学(第二军医大学)长海医院脑血管病中心住院治疗的51例隐源性脑卒中合并PFO患者的临床特点、影像学表现和治疗效果。结果 51例患者中男41例,女10例;年龄为21~84岁,平均年龄为(53.92±14.83)岁。磁共振弥散加权成像(DWI)检查示46例患者有新发梗死灶,包括单发梗死灶20例(43.5%)、多发梗死灶26例(56.5%);26例多发梗死灶患者中15例(57.7%)仅累及1个动脉供血区,11例(42.3%)累及2个及2个以上动脉供血区(双侧前循环4例、前后循环7例)。37例患者行经颅多普勒超声发泡试验(cTCD)检查,发现31例(83.8%)可见空气微泡栓子信号,其中4例空气微泡栓子信号呈雨状或帘状。50例患者行经食管超声心动图(TEE)检查,发现49例(98.0%)合并PFO。9例患者接受静脉溶栓治疗;18例患者接受单联抗血小板治疗、12例接受双联抗血小板治疗、8例接受华法林抗凝治疗、13例行PFO封堵术+单联抗血小板治疗;6个月后随访单联抗血小板治疗患者中再发缺血性脑卒中1例,双联抗血小板治疗患者中再发缺血性脑卒中2例,PFO封堵术患者无再发脑卒中事件。结论 隐源性脑卒中合并PFO梗死灶可累及1个或多个动脉供血区;cTCD和TEE检查诊断PFO阳性率高;选择性抗栓或PFO封堵术治疗患者脑卒中再发风险低。
关键词:  隐源性脑卒中  卵圆孔未闭  经颅多普勒超声发泡试验  经食管超声心动图
DOI:10.16781/j.0258-879x.2018.09.1061
投稿时间:2018-07-30修订日期:2018-08-23
基金项目:上海市科技创新行动计划重点项目(14401970304).
Clinical characteristics of patients with cryptogenic stroke and patent foramen ovale
JIANG Yue,SHEN Hong-jian,SHEN Fang,ZHANG Ping,WU Tao,DENG Ben-qiang*
(Stroke Center, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author)
Abstract:
Objective To investigate the clinical characteristics of patients with cryptogenic stroke and patent foramen ovale (PFO). Methods The clinical features, imaging findings and therapeutic outcomes of 51 patients with cryptogenic stroke and PFO, who received treatment in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Jan. 2018, were retrospectively analyzed. Results Of the 51 cases, 41 were male and 10 were female; and the mean age was (53.92±14.83) years (ranging from 21 to 84 years). Diffusion weighted imaging (DWI) showed that 46 patients developed new infarction including 20 cases (43.5%) of single lesion and 26 cases (56.5%) of multiple lesions, of which 15 cases (57.7%) involved single arterial territory and 11 cases (42.3%) involved two or more arterial territories (4 cases of bilateral anterior circulation, and 7 cases of both the anterior and posterior circulations). Thirty-seven patients underwent contrast-enhanced transcranial Doppler (cTCD) examination, which showed that 31 cases (83.8%) had microbubble sign (air microbubble emboli of 4 cases looked like raindrops or curtains). In 50 patients undergoing transesophageal echocardiography (TEE) examination, 49 cases (98.0%) were accompanied with PFO. Nine patients received intravenous thrombolysis. In secondary prevention, 18 patients received single antiplatelet therapy, 12 dual antiplatelet therapy, 8 anticoagulation therapy, and 13 PFO closure+single antiplatelet therapy. One patient with single antiplatelet therapy had recurrent ischemic stroke, 2 patients with dual antiplatelet therapy had recurrent ischemic stroke, and the patients with percutaneous closure of PFO had no recurrent stroke. Conclusion The infarction of cryptogenic stroke with PFO involves single or multiple arterial territories, cTCD and TEE have high positive diagnosis rate for PFO, and the patients with selective antithrombotic therapy and PFO closure have a low risk of recurrent stroke.
Key words:  cryptogenic stroke  patent foramen ovale  contrast-enhanced transcranial Doppler  transesophageal echocardiography