隐源性脑梗死合并卵圆孔未闭介入封堵术后疗效观察

Therapeutic effect of transcatheter occlusion on cryptogenic cerebral infarction complicated with patent foramen ovale

目的对隐源性脑梗死合并卵圆孔未闭行介入封堵术的病例进行分析,评价卵圆孔未闭介入封堵治疗预防脑梗死再发的效果和安全性。方法回顾研究2015年1月—2018年8月于绵阳市中心医院就诊,并确诊为脑梗死合并卵圆孔未闭,同时接受介入封堵治疗的24例患者资料,收集其相关病史、临床辅助检查和治疗过程。患者在门诊复诊时完善检查(心电图、右心声学造影、经颅多普勒超声发泡试验、头颅影像学等),同时评估临床表现,结合定期电话及门诊随访,评价脑梗死有无再发,评估有无术后并发症。结果共纳入24例患者,其中男11例,女13例;年龄16~72岁,平均49岁;美国国立卫生研究院卒中量表评分≤5分者19例,>5分者5例。24例患者术前行颅脑MRI等检查明确存在神经系统事件,其中单侧脑梗死灶21例,双侧脑梗死3例;单发病灶10例,多发病灶14例;皮质梗死9例,皮质下梗死15例;前循环受累14例,后循环受累8例,前后循环均受累2例;腔隙性梗死11例,非腔隙性梗死13例。24例患者择期行介入治疗封堵卵圆孔,全部封堵成功,住院期间及出院后随访3、6、12个月均无并发症,均未再发生脑梗死。结论运用介入封堵的方法治疗卵圆孔未闭从而预防脑梗死再发的效果显著,且手术安全性高,术后并发症少见。

Objective To analyze the cases of cryptogenic cerebral infarction complicated with patent foramen ovale(PFO)treated by interventional occlusion,and evaluate the efficacy and safety of occlusion of PFO on preventing the recurrence of cerebral infarction.Methods A total of 24 patients with cerebral infarction complicated with PFO who underwent interventional occlusion from January 2015 to August 2018 in Mianyang Central Hospital were retrospectively analyzed.The data of these patients was collected,including relevant medical history,clinical examinations,and treatment processes.Detailed examinations(electrocardiogram,right heart contrast echocardiography,transcranial Doppler ultrasound foaming test,cranial imaging,etc.)were performed and the clinical manifestations were evaluated when patients returned to the outpatient department.Combining with regular telephone calls and outpatient follow-up,the recurrence of cerebral infarction and postoperative complications were evaluated.Results Among the 24 patients,there were 11 males and 13 females,who were aged from 16 to 72(with an average age of 49);the National Institutes of Health Stroke Scale Score was≤5 in 19 patients,and was>5 in 5.The preoperative MRI and other examinations of the 24 patients showed that there were 21 cases of unilateral cerebral infarctions and 3 cases of bilateral cerebral infarctions;10 cases of single lesions and 14 cases of multiple lesions;9 cases of cortical infarctions and 15 cases of subcortical infarctions;11 cases of lacunar infarctions and 13 cases of non-lacunar infarctions.Anterior circulation was involved in 14 cases,posterior circulation was involved in 8 cases,and both anterior and posterior circulations were involved in 2 cases.All the 24 patients underwent interventional occlusion successfully.No complications occurred during hospitalization or 3,6,and 12 months of follow-up visits.No cerebral infarctions reoccurred.Conclusions Interventional occlusion of PFO is effective on preventing the recurrence of cerebral infarction.And the operation is safe with rare complications.