Paradoxe Hirnembolie : Nachweis von Risikofaktoren für Rezidive und Strategien zur Sekundärprophylaxe
Background: It is unclear what kind of role is played by concomitant risk factors in stroke recurrence and whether medical or invasive (surgical or catheter interventional) treatment is preferable to prevent recurrence of cerebral ischemia in patients with patent foramen ovale (PFO) as a suspected cause of stroke. Methods: During a prospective follow-up over a mean time of 52 ñ 32 months 124 patients (mean age 51 ñ 15 years) with cryptogenic cerebral ischemia and PFO were included in this study. Recurrent ischemic events and risk factors for stroke recurrence were analyzed. Of all patients, a number of 83 were treated purely medically, 34 patients received transcatheter closure and 7 surgical closure of the foramen ovale. The annual stroke recurrence rates of the special treatments were being compared in the study. Results: The general annual stroke recurrence rate was low (2,1/year). Significant cofactors of recurrent were a large shunt (p<0,05) and a history of pulmonary embolism (p<0,01). The annual stroke recurrence rates are comparable in catheter-based and medically treated patients (3,0/year or 2,2/year). Both patients suffering from recurrence after transcatheter closure (n=2) had residual shunts. Conclusions: The absolute risk of recurrent cerebrovascular events in patients with PFO receiving medical or invasive therapy is low. For risk classification, the shunt size, the recurrence of pulmonary embolism and the recurrence the recurrence in spite of medical treatment should be carefully determined. Although the majority of patients is efficiently medicaly treated, certain high-risk groups may benefit from definite closure (priority transcatheter closure in specialized centers) of the foramen ovale.
info:eu-repo/classification/ddc/610, Medizin, Paradoxe Hirnembolie, persistierendes Foramen ovale, Risikofaktoren, Sekundärprophylaxe
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