房间隔结构异常致缺血性卒中患者的介入封堵治疗

doi:10.3969/j.issn.1006-7795.2016.01.010

首都医科大学学报 ›› 2016, Vol. 37 ›› Issue (1): 48-53.doi: 10.3969/j.issn.1006-7795.2016.01.010

• 心脑血管疾病临床与基础研究 • 上一篇下一篇

房间隔结构异常致缺血性卒中患者的介入封堵治疗

付强¹, 赵敏¹, 张倩², 丁则昱², 杜丽娟³, 王伊龙², 曲辉², 董可辉², 陈步星¹, 王拥军²

1. 首都医科大学附属北京天坛医院心血管内科, 北京 100050;
2. 首都医科大学附属北京天坛医院血管神经病学中心, 北京 100050;
3. 首都医科大学附属北京天坛医院超声科, 北京 100050

收稿日期:2015-12-10 出版日期:2016-02-21 发布日期:2016-02-01
通讯作者: 陈步星, 王拥军 E-mail:chbux@126.com;yongjunwang62@gmail.com
基金资助:
北京市卫生系统高层次卫生技术人才培养计划(2011-3-026)。

Transcatheter closure of atrial septal abnormalities (PFO, ASD) in patients with ischemic stroke

Fu Qiang¹, Zhao Min¹, Zhang Qian², Ding Zeyu², Du Lijuan³, Wang Yilong², Qyu Hui², Dong Kehui², Chen Buxing¹, Wang Yongjun²

1. Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China;
2. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China;
3. Department of Ultrasonography, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China

Received:2015-12-10 Online:2016-02-21 Published:2016-02-01
Supported by:
This study was supported by Beijing Health System High Level Health Technical Personnel Training Plan(2011-3-026).

摘要/Abstract

摘要： 目的探讨经导管房间隔结构异常封堵治疗缺血性卒中患者的临床效果及预后。方法以2015年5月至11月在首都医科大学附属北京天坛医院接受房间隔结构异常封堵治疗的缺血性卒中患者为研究对象。封堵术前,所有入选患者均经经颅多普勒超声(contrast transcranial Doppler ultrasound, cTCD)发泡试验证实有右向左分流(right-left shunt, RLS)以及经食管超声证实存在卵圆孔未闭(patent foramen ovale, PFO)或房间隔缺损(atrial septal defect, ASD)。封堵术后复查cTCD发泡试验及经胸超声心动图,观察手术效果,完全封堵及合并症情况,评价疗效及安全性。结果本研究共纳入10例患者,平均年龄(48±14)岁,其中男性8例,女性2例, PFO患者8例,ASD患者2例。所有患者术前cTCD发泡试验均证实为大量RLS。PFO直径1.1~2.0 mm,平均(1.7±0.3)mm。ASD直径分别为4.5 mm和3.4 mm。手术成功率100%。8例PFO患者使用的封堵器型号均为18/25 mm,2例ASD封堵器的型号分别为12 mm和10 mm。封堵术后仅1例PFO患者在cTCD发泡试验中有中等量残余分流,完全封堵率90%。术后1、3、6个月随访,未见封堵器移位及表面血栓形成,未见脑缺血事件复发。结论经导管PFO/ASD封堵术在缺血性卒中患者中应用是安全、有效的,能显著减少右向左分流,但需注意封堵术后中远期残余右向左分流的随访观察。

关键词: 缺血性卒中, 卵圆孔未闭, 房间隔缺损, 经导管封堵

Abstract: Objective To evaluate effective transcatheter atrial septal abnormalities (patent foramen ovale, PFO or atrial septal defect, ASD) closure rate and outcome in patients with ischemic stroke. Methods Ischemic stroke patients who underwent transcatheter closure of atrial septal abnormalities at Beijing Tiantan Hospital between May 2015 and November 2015 were enrolled. Right-left shunts (RLS) were confirmed by contrast transcranial Doppler ultrasound, and PFO or ASD were detected by transesophageal echocardiograph before transcatheter closure. Success rate of device implantation, completed closure rate and complications were evaluated. Results Ten patients [(48±14) years, 8 male and 2 female, 8 PFO and 2 ASD] were included in the study. Before closure, severe RLSs were detected in all patients. PFO size was (1.7±0.3) mm and ASD size was 4.5 mm and 3.4 mm. The procedure of device placement was successful in all patients. The 18/25 mm of PFO occluders were implanted in 8 PFO patients. The 12 mm and 10 mm ASD occluders were implanted in 2 ASD patients. Moderate residual RLS was present in 1 patient after PFO closure, and thus completed closure rate was 90%. Neither occluder malposition and thrombus,nor neurological recurrences were observed at 1, 3, and 6 months. Conclusion Transcatheter PFO or ASD closure is an effective and safe procedure in patients with ischemic stroke and can decrease RLS. However, it is necessary to evaluate residual RLS in mid-and long-term follow-up.

Key words: ischemic stroke, patent foramen ovale, atrial septal defect, transcatheter closure

中图分类号:

R541.1

付强, 赵敏, 张倩, 丁则昱, 杜丽娟, 王伊龙, 曲辉, 董可辉, 陈步星, 王拥军. 房间隔结构异常致缺血性卒中患者的介入封堵治疗[J]. 首都医科大学学报, 2016, 37(1): 48-53.

Fu Qiang, Zhao Min, Zhang Qian, Ding Zeyu, Du Lijuan, Wang Yilong, Qyu Hui, Dong Kehui, Chen Buxing, Wang Yongjun. Transcatheter closure of atrial septal abnormalities (PFO, ASD) in patients with ischemic stroke[J]. Journal of Capital Medical University, 2016, 37(1): 48-53.

参考文献

[1] Hagen P T, Scholz D G, Edwards W D. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts[J]. Mayo Clin Proc, 1984,59(1):17-20.
[2] Windecker S, Wahl A, Nedeltchev K, et al. Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke[J]. J Am Coll Cardiol, 2004,44(4):750-758.
[3] Wahl A, Jüni P, Mono M L, et al. Long-term propensity score-matched comparison of percutaneous closure of patent foramen ovale with medical treatment after paradoxical embolism[J]. Circulation, 2012,125(6):803-812.
[4] Bannan A, Shen R, Silvestry F E, et al. Characteristics of adult patients with atrial septal defects presenting with paradoxical embolism[J]. Catheter Cardiovasc Interv, 2009,74(7):1066-1069.
[5] Kent D M, Ruthazer R, Weimar C, et al.An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke[J]. Neurology, 2013,81(7):619-625.
[6] Ning M, Lo E H, Ning P C, et al.The brain's heart-therapeutic opportunities for patent foramen ovale (PFO) and neurovascular disease[J]. Pharmacol Ther, 2013, 139(2):111-123.
[7] Sacco R L, Foulkes M A, Mohr J P, et al. Determinants of early recurrence of cerebral infarction. The Stroke Data Bank[J]. Stroke,1989,20(8):983-989.
[8] Davis D, Gregson J, Willeit P, et al. Patent foramen ovale, ischemic stroke and migraine: systematic review and stratified meta-analysis of association studies[J]. Neuroepidemiology, 2013,40(1):56-67.
[9] 陈晓峰, 陈宝成,于川. 青年脑卒中116例数字减影血管造影分析及病因探讨[J]. 中国煤炭工业医学杂志,2013,16(3):398.
[10] 顾美娟, 王大力. 缺血性脑卒中预后风险述评[J]. 中国煤炭工业医学杂志,2015,18(2):339-342.
[11] 张颖冬. 脑血管病相关性运动障碍的认识现状[J]. 中国脑血管病杂志,2014,11(2):57-63.
[12] Harvey J R, Teague S M, Anderson J L, et al. Clinically silent atrial septal defects with evidence for cerebral embolization[J]. Ann Intern Med, 1986, 105(5):695-697.
[13] Khositseth A, Cabalka A K, Sweeney J P, et al. Transcatheter Amplatzer device closure of atrial septal defect and patent foramen ovale in patients with presumed paradoxical embolism[J]. Mayo Clin Proc, 2004, 79(1):35-41.
[14] Lamy C, Giannesini C, Zuber M, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm[J]. Stroke, 2002, 33(3):706-711.
[15] Homma S, Di Tullio M R, Sacco R L, et al. Characteristics of a patent foramen ovale associated with cryptogenic stroke. A biplane transesophageal echocardiographic study[J]. Stroke, 1994, 25(3):582-586.
[16] De Castro S, Cartoni D, Fiorelli M, et al. Morphological and functional characteristics of patent foramen ovale and their embolic implications[J]. Stroke, 2000, 31(10):2407-2413.
[17] Stone D A, Godard J, Corretti M C, et al. Patent foramen ovale: association between the degree of shunt by contrast transesophageal echocardiography and the risk of future ischemic neurologic events[J]. Am Heart J, 1996, 131(1):158-161.
[18] Pandit A, Aryal M R, Pandit A A, et al.Amplatzer PFO occluder device may prevent recurrent stroke in patients with patent foramen ovale and cryptogenic stroke: a meta-analysis of randomised trials[J]. Heart Lung Circ, 2014,23(4):303-308.
[19] Carroll J D, Saver J L, Thaler D E, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke[J]. N Engl J Med, 2013,368(12):1092-1100.
[20] 张玉顺, 朱鲜阳. 卵圆孔未闭处理策略中国专家建议[J]. 心脏杂志, 2015, 27(4):373-379.
[21] Braun M, Gliech V, Boscheri A, et al. Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism. Periprocedural safety and mid-term follow-up results of three different device occludersystems[J]. Eur Heart J, 2004, 25(5):424-430.
[22] Matsumura K, Gevorgyan R, Mangels D, et al.Comparison of residual shunt rates in five devices used to treat patent foramen ovale[J]. Catheter Cardiovasc Interv, 2014,84(3):455-463.
[23] Caputi L, Butera G, Anzola G P, et al. Residual shunt after patent foramen ovale closure: preliminary results from italian patent foramen ovalesurvey[J]. J Stroke Cerebrovasc Dis, 2013, 22(7): e219-226.
[24] Van de Bruaene A, Stroobants D, Benit E. Percutaneous closure of inter-atrial communications (atrial septal defect and patent foramen ovale): single-centre experience and mid-term follow-up[J]. Acta Cardiol, 2015,70(2):133-140.
[25] Marchese N, Pacilli M A, Inchingolo V, et al.Residual shunt after percutaneous closure of patent foramen ovale with AMPLATZER occluder devices-influence of anatomic features: a transcranial Doppler and intracardiac echocardiography study[J]. EuroIntervention, 2013, 9(3):382-388.
[26] 李世军, 岳庆雄,王苏平,等. 卵圆孔未闭介入封堵治疗及近期随访研究[J].中国循环杂志, 2014, 29(6):448-452.
[27] von Bardeleben R S, Richter C, Otto J, et al. Long term follow up after percutaneous closure of PFO in 357 patients with paradoxical embolism: Difference in occlusion systems and influence of atrial septum aneurysm[J]. Int J Cardiol, 2009,134(1):33-41.

房间隔结构异常致缺血性卒中患者的介入封堵治疗

Transcatheter closure of atrial septal abnormalities (PFO, ASD) in patients with ischemic stroke

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 3

编辑推荐

Metrics

本文评价

[1]	李雪, 范俊芬, 王荣亮, 马青峰, 罗玉敏, 赵海苹. HDAC2对急性缺血性卒中患者中性粒细胞TBC蛋白家族成员的表观调控[J]. 首都医科大学学报, 2023, 44(1): 62-71.
[2]	王雨萌, 何文, 杜丽娟, 付强, 张惠琴, 黄文燕, 李元子. 二维斑点追踪技术评估卵圆孔未闭封堵术后左心房功能[J]. 首都医科大学学报, 2019, 40(6): 842-845.
[3]	黄镪, 马青峰, 宋海庆, 武剑. 血糖对急性缺血性卒中静脉溶栓治疗后结局的影响[J]. 首都医科大学学报, 2017, 38(1): 53-58.