Therapeutic effect of transcatheter occlusion on cryptogenic cerebral infarction complicated with patent foramen ovale_West China Medical Journal

Authors：

ZHANG Shanshan , DUAN Jingfeng , LI Zhaokun , YANG Bufan ,  TANG Yufeng

Department of Neurology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding?author：

TANG Yufeng, Email: tyftangtang@126.com

Keywords：

Cryptogenic cerebral infarction; Patent foramen ovale; Transcatheter occlusion

DOI：

10.7507/1002-0179.201907211

Video：

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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.

Citation： ZHANG Shanshan, DUAN Jingfeng, LI Zhaokun, YANG Bufan, TANG Yufeng. Therapeutic effect of transcatheter occlusion on cryptogenic cerebral infarction complicated with patent foramen ovale. West China Medical Journal, 2019, 34(10): 1138-1142. doi: 10.7507/1002-0179.201907211 Copy

1.	Liberman AL, Prabhakaran S. Cryptogenic stroke: how to define it? How to treat it?. Curr Cardiol Rep, 2013, 15(12): 423.
2.	Finsterer J. Management of cryptogenic stroke. Acta Neurol Belg, 2010, 110(2): 135-147.
3.	Kim DW, Cho JS, Cho JY, et al. The association between aortic regurgitation and undetermined embolic infarction with aortic complex plaque. Int J Stroke, 2017, 13(4): 391-399.
4.	Lippi G, Favaloro EJ, Franchini M. Paradoxical thrombosis part 1: factor replacement therapy, inherited clotting factor deficiencies and prolonged APTT. J Thromb Thrombolysis, 2012, 34(3): 360-366.
5.	馬冰, 陳欣, 劉奕婷, 等. 卵圓孔未閉與中老年人隱源性卒中關系的Meta分析. 中國循證心血管醫學雜志, 2013, 5(5): 453-456.
6.	Trabattoni D, Fabbiocchi F, Montorsi PA, et al. Sustained long-term benefit of patent foramen ova le closure on migraine. Catheter Cardiovasc Interv, 2011, 77(4): 570-574.
7.	Sondergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med, 2017, 377(11): 1033-1042.
8.	Bailey EL, Smith C, Sudlow CL, et al. Pathology of lacunar ischemic stroke in Humansu: a systematic review. Brain Pathol, 2012, 22(5): 583-591.
9.	Meissner I, Khandheria BK, Heit JA, et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol, 2006, 47(2): 440-445.
10.	Del Sette M, Rizzi D, Pretta S, et al. Magnitude of right-to-left shunt as the only determinant of stroke in a pair of identical twins. Neurol Sci, 2004, 25(3): 148-150.
11.	Steiner MM, Di Tullio MR, Rundek T, et al. Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke. Stroke, 1998, 29(5): 944-948.
12.	Staubach S, Steinberg DH, Zimmermann WA, et al. New onset atrial fibrillation after patent foramen ovale closure. Catheter Cardiovasc Interv, 2009, 74(6): 889-895.
13.	Liu JR, Pl?tz BM, Rohr A, et al. Association of right-to-left shunt with frontal white matter lesions in T2-weighted MR imaging of stroke patients. Neuroradiology, 2009, 51(5): 299-304.
14.	Wolf ME, Szabo K, Griebe M, et al. Clinical and MRI characteristics of acute migrainous infarction. Neurology, 2011, 76(22): 1911-1917.
15.	Carroll JD, Saver JL, Thaler DE, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med, 2013, 368(12): 1092-1100.
16.	Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med, 2017, 377(11): 1011-1021.
17.	Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med, 2017, 377(11): 1022-1032.
18.	Shah R, Nayyar M, Jovin IS, et al. Device closure versus medical therapy alone for patent foramen ovale in patients with cryptogenic stroke a systematic review and meta-analysis. Ann Intern Med, 2018, 168(5): 335-342.
19.	De Rosa S, Sievert H, Sabatino JA, et al. Percutaneous closure versus medical therapy alone for cryptogenic stroke patients with a patent foramen ovale: meta-analysis of randomized controlled trials. Ann Intern Med, 2018, 168(5): 343-350.
20.	付強, 郭彩霞, 杜麗娟, 等. 經導管封堵術治療不明原因卒中合并卵圓孔未閉患者的臨床療效及預后. 中華心血管病雜志, 2018, 46(11): 882-886.

1. Liberman AL, Prabhakaran S. Cryptogenic stroke: how to define it? How to treat it?. Curr Cardiol Rep, 2013, 15(12): 423.
2. Finsterer J. Management of cryptogenic stroke. Acta Neurol Belg, 2010, 110(2): 135-147.
3. Kim DW, Cho JS, Cho JY, et al. The association between aortic regurgitation and undetermined embolic infarction with aortic complex plaque. Int J Stroke, 2017, 13(4): 391-399.
4. Lippi G, Favaloro EJ, Franchini M. Paradoxical thrombosis part 1: factor replacement therapy, inherited clotting factor deficiencies and prolonged APTT. J Thromb Thrombolysis, 2012, 34(3): 360-366.
5. 馬冰, 陳欣, 劉奕婷, 等. 卵圓孔未閉與中老年人隱源性卒中關系的Meta分析. 中國循證心血管醫學雜志, 2013, 5(5): 453-456.
6. Trabattoni D, Fabbiocchi F, Montorsi PA, et al. Sustained long-term benefit of patent foramen ova le closure on migraine. Catheter Cardiovasc Interv, 2011, 77(4): 570-574.
7. Sondergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med, 2017, 377(11): 1033-1042.
8. Bailey EL, Smith C, Sudlow CL, et al. Pathology of lacunar ischemic stroke in Humansu: a systematic review. Brain Pathol, 2012, 22(5): 583-591.
9. Meissner I, Khandheria BK, Heit JA, et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol, 2006, 47(2): 440-445.
10. Del Sette M, Rizzi D, Pretta S, et al. Magnitude of right-to-left shunt as the only determinant of stroke in a pair of identical twins. Neurol Sci, 2004, 25(3): 148-150.
11. Steiner MM, Di Tullio MR, Rundek T, et al. Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke. Stroke, 1998, 29(5): 944-948.
12. Staubach S, Steinberg DH, Zimmermann WA, et al. New onset atrial fibrillation after patent foramen ovale closure. Catheter Cardiovasc Interv, 2009, 74(6): 889-895.
13. Liu JR, Pl?tz BM, Rohr A, et al. Association of right-to-left shunt with frontal white matter lesions in T2-weighted MR imaging of stroke patients. Neuroradiology, 2009, 51(5): 299-304.
14. Wolf ME, Szabo K, Griebe M, et al. Clinical and MRI characteristics of acute migrainous infarction. Neurology, 2011, 76(22): 1911-1917.
15. Carroll JD, Saver JL, Thaler DE, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med, 2013, 368(12): 1092-1100.
16. Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med, 2017, 377(11): 1011-1021.
17. Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med, 2017, 377(11): 1022-1032.
18. Shah R, Nayyar M, Jovin IS, et al. Device closure versus medical therapy alone for patent foramen ovale in patients with cryptogenic stroke a systematic review and meta-analysis. Ann Intern Med, 2018, 168(5): 335-342.
19. De Rosa S, Sievert H, Sabatino JA, et al. Percutaneous closure versus medical therapy alone for cryptogenic stroke patients with a patent foramen ovale: meta-analysis of randomized controlled trials. Ann Intern Med, 2018, 168(5): 343-350.
20. 付強, 郭彩霞, 杜麗娟, 等. 經導管封堵術治療不明原因卒中合并卵圓孔未閉患者的臨床療效及預后. 中華心血管病雜志, 2018, 46(11): 882-886.

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