Study On The Correlation Between Patent Foramen Ovale And Cryptogenic Stroke

Objective: To investigate the incidence of patent foramen ovale in patients with cryptogenic stroke;to understand the benefit of PFO interventional occlusion on stroke recurrence in patients with acute ischemic stroke complicated with patent foramen ovale 18 months later,that is,whether it will reduce the risk of stroke recurrence;to explore whether age,sex,foramen ovale size and other factors are one of the causes of recurrence in patients with ischemic stroke complicated with patent foramen ovale.Methods: Selected patients(9469 cases in total)who were hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University from September 15,2018 to March 15,2019 and were clinically diagnosed with acute ischemic stroke.According to TOAST classification,the concept of cryptogenic stroke and the results of right-heart contrast echocardiography,investigate the incidence of patent foramen ovale in cryptogenic stroke patients aged 18-65 years,and according to the TOAST classification and the concept of cryptogenic stroke,the 18-65-year-old ischemic stroke with oval Patients with patent foramen(a total of 104 cases)were divided into cryptogenic stroke combined with patent foramen ovale group(CS group,58 cases(58/104))and Non-cryptogenic stroke with patent foramen ovale group(NCS group,46 cases(46/104)),and the patients were divided into surgical group and non-surgical group according to whether they received interventional therapy or only medication.Record the general characteristics of each group,such as age,sex,etc.(Patients ≥18 years old and≤44 years old are classified as young group,patients ≥45 years old and ≤59years old are classified as middle-aged group,and patients ≥60 years old and≤65 years old are classified as presenile group.)And record the number of microbubbles in the results of the right-sided contrast echocardiography(using the number of microbubbles appearing in the left atrium on the static single-frame image displayed on the cardiac ultrasound instrument as the standard,the right-to-left shunt(RLS)is divided into 4 levels: Grade 0: no microbubbles in the left atrium;Grade I(small amount): 1-10microbubbles/frame in the left atrium;Grade II(medium): 11-30microbubbles/frame in the left atrium;Grade III(A large number of): In the left atrium> 30 microbubbles/frame or the left atrium is almost full of microbubbles and the heart cavity is turbid),follow the 18-month survival rate and recurrence rate,and compare the the difference in the recurrence rate of ischemic stroke between the operation group and the non-operation group,and compare whether the changes in different age groups or different genders and the number of microvesicles have an impact on the recurrence rate of ischemic stroke,the statistical method adopts the IBM SPSS 22.0 statistical software for analysis.The experimental data were expressed in the form of mean±standard deviation,and the difference between the operation group and the non-operation group was compared respectively.The significant difference was analyzed by the χ test,and the difference was statistically significant with P<0.05.Results:1.Cryptogenic stroke patients with patent foramen ovale accounted for37.42% of the total patients with cryptogenic stroke.2.Exclude 13 patients who could not be contacted,there are 45 patients in the cryptogenic stroke combined with patent foramen ovale group.Among them,4 patients(30.77%)in the surgical group recurred at 18 months,and 7patients in the non-surgical group(21.88%)),the difference between the two groups was not statistically significant(χ~2=1.693,P=0.534>0.05).The patients were divided by gender.Among the male patients(37 cases in total),2 cases(22.22%)relapsed at 18 months in the surgical group and 7 cases(25%)relapsed at 18 months in the non-operation group.There was no statistically significant difference between the two groups(χ~2 =0.028,P=0.868 >0.05).Among female patients(a total of 8 cases),2 cases(50%)in the surgical group had recurrence at 18 months,and the non-surgical group had no recurrence at 18 months.The difference between the two groups was not statistically significant(χ~2= 2.333,P=0.127>0.05).The patients were divided according to age.In the youth group(a total of 13 cases),2 cases(40%)in the surgical group recurred at 18 months,and the non-surgical group did not relapse at 18 months.The difference between the two groups was not statistically significant(χ~2=3.491,P= 0.062>0.05).In the middle-aged group(a total of 20 cases),1 case(14.29%)relapsed at 18 months in the operation group and 4 cases(30.77%)relapsed at 18 months in the non-operation group.There was no statistically significant difference between the two groups(χ~2=0.626,P= 0.429>0.05);in the pre-elderly group(12 cases in total),1 case(100%)recurred at 18 months in the operation group,and 3 cases(27.27%)relapsed at 18 months in the non-operation group.There was no significant difference between the two groups(χ~2 =2.000,P=0.157>0.05);in the medium to large number of microbubble group(39 cases in total),4 cases(30.77%)in the operation group recurred at 18 months,and 5 cases(19.23%)in the non-operation group relapsed at 18 months,two There was no statistically significant difference between the groups(χ~2=0.633,P=0.426>0.05).3.Except for 6 people who could not be contacted,there were 40 patients with non-cryptogenic stroke combined with patent foramen ovale.Among them,1 case(11.11%)recurred within 18 months in the surgical group and 4cases(12.90%)in the non-surgical group.),the results between the two groups were not statistically significant(χ~2=0.020,P=0.888>0.05).The patients were divided by gender.Among the male patients(32 cases in total),1 case(14.29%)relapsed within 18 months in the surgical group and 4 cases(16%)relapsed within 18 months in the non-operative group.There was no significant difference between the two groups.(χ~2=0.012,P=0.913 >0.05).In female patients(8 cases in total),there was no recurrence in the surgical group for 18 months,and no recurrence in the non-surgical group for 18 months.The comparison between the two groups is meaningless.The patients were divided according to age.In the youth group(a total of 7 cases),there was no recurrence in the surgical group for 18 months and the non-surgical group without recurrence at 18 months.The comparison between the two groups is meaningless.In the middle-aged group(20 cases in total),1 case(20%)recurred at 18 months in the operation group,and 2 cases(13.33%)relapsed at 18 months in the non-operation group.There was no significant difference between the two groups(χ~2=0.124,P= 0.725>0.05);in the pre-elderly group(a total of 13 cases),there was no recurrence in the surgical group at 18 months,and 2 cases in the non-surgical group(27.27%)at 18 months.There was no significant difference between the two groups(χ~2=0.397,P= 0.529>0.05).In the medium to large number of microbubble group(31 cases in total),1 case(11.11%)recurred at 18 months in the operation group and 3 cases(13.64%)relapsed at 18 months in the non-operation group.There was no significant difference between the two groups(χ~2=0.035),P=0.851>0.05).Conclusions:1.Cryptogenic stroke patients with patent foramen ovale account for about 37.42% of the total number of cryptogenic stroke patients.2.Among patients with cryptogenic stroke and patent foramen ovale,there was no significant difference in the recurrence rate of ischemic stroke between the operation group and the non-operation group.Moreover,there was no statistically significant difference in the recurrence rate of ischemic stroke between the surgical group and the non-surgical group of different ages and genders.3.Among patients with non-cryptogenic stroke and patent foramen ovale,there was no significant difference in the recurrence rate of ischemic stroke between the operation group and the non-operation group.Moreover,there was no statistically significant difference in the recurrence rate of ischemic stroke between the surgical group and the non-surgical group of different ages and genders.