Cerebrovasc Dis:卵圆孔未闭介入治疗有效预防隐源性卒中复发

2018-04-18 国际循环编辑部 国际循环

卵圆孔未闭(PFO)合并房间隔膨胀瘤(ASA)患者是隐源性卒中的主要易发群体。经皮穿刺介入治疗PFO与药物治疗两种方法孰优孰劣,学界仍存在巨大分歧,研究者希望通过荟萃分析的方式,找出更为安全有效预防卒中复发的选择。

卵圆孔未闭(PFO)合并房间隔膨胀瘤(ASA)患者是隐源性卒中的主要易发群体。经皮穿刺介入治疗PFO与药物治疗两种方法孰优孰劣,学界仍存在巨大分歧,研究者希望通过荟萃分析的方式,找出更为安全有效预防卒中复发的选择。

研究者对PubMed、Medline和Cochrane Central Register中的随机对照试验(RCT)进行检索,获得共282项比较隐源性卒中患者行PFO介入治疗与药物治疗效果的研究,最终纳入其中5项研究进行分析,共纳入3440例患者(平均年龄45岁,平均随访时间2.9年),其中PFO介入治疗组1829例,药物治疗组1611例。研究设定的主要结局是卒中复发的降低情况,采用随机效应模型对汇总数据的主要结局进行测定,结果用集中率比(RR)表示。

研究者采用随机效应模型将纳入的研究结果整合后显示,与药物治疗组相比,PFO封堵组卒中复发风险下降显著(RR=0.42;P=0.03),即PFO介入治疗能更为安全有效预防隐源性卒中的复发。

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    2018-07-17 quxin068
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1635292, encodeId=3990163529289, content=<a href='/topic/show?id=42ce985294b' target=_blank style='color:#2F92EE;'>#隐源性卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98529, encryptionId=42ce985294b, topicName=隐源性卒中)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33a222440448, createdName=新生儿张玉军, createdTime=Mon Oct 22 01:19:00 CST 2018, time=2018-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1938834, encodeId=68e91938834cc, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Tue Jul 17 08:19:00 CST 2018, time=2018-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012635, encodeId=7a5f201263543, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Tue Jun 12 02:19:00 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391616, encodeId=74e0139161634, content=<a href='/topic/show?id=f8ab3603664' target=_blank style='color:#2F92EE;'>#卒中复发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36036, encryptionId=f8ab3603664, topicName=卒中复发)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLc3PoqaNe4QTZ947pojXuchvvmkkJN0wyBBbA3LVX2WDkgiaJ7cswu9yvA4CB0NicjcrCfBY1zRPkA/132, createdBy=b3812500089, createdName=ms6897892027066920, createdTime=Fri Apr 20 13:19:00 CST 2018, time=2018-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026022, encodeId=48be102602280, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Thu Apr 19 01:19:00 CST 2018, time=2018-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=307046, encodeId=b57630e046d7, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Wed Apr 18 22:41:11 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=307034, encodeId=617d30e034db, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Wed Apr 18 22:33:30 CST 2018, time=2018-04-18, status=1, ipAttribution=)]
    2018-04-19 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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    2018-04-18 wqkm

    ^_^^_^^_^^_^

    0

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    2018-04-18 戒馋,懒,贪

    谢谢分享学习了

    0

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在隐源性卒中患者中,PFO封堵在预防进一步卒中方面优于药物治疗:对于中-大分流患者尤其如此。

N Engl J Med:卒中后卵圆孔未闭封堵术联合抗血小板治疗有何利弊?

2017年9月,发表在《N Engl J Med.》的一项多中心、随机化、开放标签试验调查了卒中后卵圆孔未闭封堵术或抗凝vs抗血小板治疗的疗效。

NEJM:卵圆孔未闭封堵术vs抗血小板,抗血小板vs抗凝

病例对照研究显示卵圆孔未闭(PFO)与隐源性卒中有关,特别是年龄小于55岁和合并房间隔动脉瘤或大量右向左分流的患者。在这些患者中,关闭PFO预防卒中复发的疗效尚不清楚。闭合卵圆孔理论上应该能够降低卒中复发风险,但是几项随机对照试验并没有发现PFO闭合优于抗栓治疗。

Stroke:不明原因卒中或短暂性脑缺血发作患者卵圆孔未闭封堵和药物治疗比较!

由此可见,不明原因卒中/TIA合并PFO患者中接受PFO封闭治疗,与接受药物治疗的患者相比,缺血性卒中复发发生频率较低。房颤发生更频繁,但大多是短暂的。TIA、全因死亡或心肌梗塞没有显著差异。

ACC 2018:封堵vs.药物治疗,高危卵圆孔未闭隐源性脑卒中二级预防孰优孰劣?

美国当地时间3月12日,ACC2018最新发布的DEFENSE-PFO研究结果显示,高危卵圆孔未闭(PFO)的患者在发生隐源性脑卒中后,接受封堵治疗比单纯药物治疗2年时间内有更好的临床结局。

JAMA:术前卵圆孔未闭是重要的围手术期中风风险因素

研究认为,术前卵圆孔未闭是重要的围手术期中风风险因素