在病因不明的中风年轻患者中,大血管闭塞在高危的卵圆孔未闭组中发生率较低

IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Revue neurologique Pub Date : 2024-06-01 DOI:10.1016/j.neurol.2023.11.002
A. Ter Schiphorst , A. Lippi , L. Corti , I. Mourand , P. Prin , A. Agullo , F. Cagnazzo , J.-C. Macia , C. Arquizan
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引用次数: 0

摘要

导言在病因未明的卒中年轻患者中,有相当一部分存在闭孔 (PFO),但并不总是因果关系。因此,已开发出一些分类方法(RoPE、PASCAL)来确定 PFO 是卒中病因的可能性。然而,在建立这些分类时,并未将是否存在初始动脉闭塞作为预测因素进行研究。我们的目的是评估病因不明、伴有/不伴有高危 PFO 的年轻中风患者中是否存在动脉闭塞。方法我们从一个前瞻性建立的单中心数据库中确定了年龄≥ 18 至 60 岁、病因不明的中风患者,并进行了完整的病因学检查,包括经食道超声心动图检查。我们将患者分为两组:(i) 高危 PFO 患者[即 PFO 伴有较大的房室间分流(30 微气泡)或伴有房间隔动脉瘤];(ii) 低危/无 PFO 患者。我们记录了急性期动脉闭塞和大血管闭塞(LVO)的情况。他们的中位年龄为 48(40-52)岁,28(29%)人为女性。高危 PFO 组中动脉闭塞和 LVO 患者的比例低于低危/无 PFO 组:分别为 11 (20%) 对 19 (46%) (P = 0.008) 和 5 (9%) 对 15 (37%) (P = 0.002)。结论 LVO 的存在可作为病因未确定的卒中中 PFO 病因的 "红旗",可在未来 PFO 相关卒中分类中应用。
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In young patients with stroke of undetermined etiology, large vessel occlusions are less frequent in the group with high-risk patent foramen ovale

Introduction

Patent foramen ovale (PFO) is present in a significant proportion of young patients with stroke of undetermined etiology, but is not always causal. Therefore, classifications (RoPE, PASCAL) have been developed to determine the probability that PFO is the stroke cause. However, the presence of an initial arterial occlusion as a prediction factor was not studied when these classifications were built. Our aim was to evaluate the presence of arterial occlusion in young patients with stroke of undetermined etiology with/without high-risk PFO.

Methods

From a prospectively-built monocentric database, we identified patients aged  18 to < 60-years with strokes of undetermined etiology and complete etiological work-up, including transesophageal echocardiography. We divided patients in two groups: (i) with high-risk PFO [i.e. PFO with large interatrial shunt (> 30 microbubbles) or associated with atrial septal aneurysm] and (ii) with low-risk/without PFO. We recorded the presence of arterial occlusion and large vessel occlusion (LVO) in the acute phase.

Results

We included 96 patients; 55 (57%) had high-risk PFO. Their median age was 48 (40–52) years, and 28 (29%) were women. The percentages of patients with arterial occlusion and with LVO were lower in the high-risk PFO group than in the low-risk/without PFO group: 11 (20%) versus 19 (46%) (P = 0.008), and 5 (9%) versus 15 (37%) (P = 0.002), respectively. There was no difference in the median RoPE score between groups (P = 0.30).

Conclusion

The presence of LVO could represent a “red flag” of PFO causality in stroke of undetermined etiology, and could be implemented in future PFO-related stroke classifications.

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来源期刊
Revue neurologique
Revue neurologique 医学-临床神经学
CiteScore
4.80
自引率
0.00%
发文量
598
审稿时长
55 days
期刊介绍: The first issue of the Revue Neurologique, featuring an original article by Jean-Martin Charcot, was published on February 28th, 1893. Six years later, the French Society of Neurology (SFN) adopted this journal as its official publication in the year of its foundation, 1899. The Revue Neurologique was published throughout the 20th century without interruption and is indexed in all international databases (including Current Contents, Pubmed, Scopus). Ten annual issues provide original peer-reviewed clinical and research articles, and review articles giving up-to-date insights in all areas of neurology. The Revue Neurologique also publishes guidelines and recommendations. The Revue Neurologique publishes original articles, brief reports, general reviews, editorials, and letters to the editor as well as correspondence concerning articles previously published in the journal in the correspondence column.
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