The Clinical Characters And Therapeutic Decisions Of Ischemic Cerebro Vascular Diseases With Patent Foramen Ovale

Purpose The most common ischemic cerebrovascular diseases (ICS) includes stroke and transient ischemic attack. Patent foramen ovale (PFO) arouses worldwide attention as its might be a novel pathogenesis for ICS, but the clinical characters and prognosis are still not clear.Methods Firstly, we revealed the clinical characters of ICS with PFO in biochemical and radiological changes, by comparing to ICS with atherosclerosis. For another, we conducted a randomized, open-label trial of closure with a percutaneou device, as compared with asprine and/or clopidogrel therapy alone, in patients who presented with ICS with PFO. The primary end point was a composite of stroke, TIA or migraine during 2 years of follow-up.Results A total of 48 patients were enrolled in this trial. (1) After comparing with ICS with atherosclerosis, we found that the patients of ICS with PFO presented younger (YearPFO=43.9±11.36, Year atherosclerosis=58.2±10.74, P=0.000 < 0.05), more migraine (OR migraine=8.024, P=0.027< 0.05), lower systolic pressure (OR systolic pressure=0.138, P=0.000< 0.05), lower glycosylated hemoglobin (OR glycosylated hemoglobin=0.160, P=0.024< 0.05), lower triglycerides (ORtriglycerides=0.245, P=0.032<0.05), lower density lipoprotein (ORLDL=0.107, P=0.000< 0.05), and lower homocysteine (OR homocysteine=0.323, P=0.014< 0.05). Moreover, these patients seemed much easier to have large infarct focals (>15mm) (OR=4.6, P=0.027< 0.05) and hemorrhagic transformation (OR=21.6, P=0.001< 0.05) in iconography. (2) A total of 6 patients underwent attempted implantation and no one presented end point after 2 years of follow-up. Among the else three groups, patients underwent asprine and clopidogrel had significantly less migraine.Conclusions (1) Patients had ICS and PFO present more migraine, less abnormity in age, pressure, glucose and lipid, but seemed easier to involved in migraine. (2) Patients had ICS and PFO seemed much easier to have multiple infarct focals and hemorrhagic transformation in iconography. (3) The closure therapy might be an effective way with little adverse reaction. (4) Compared with using asprine or clopidogrel alone, the combined therapy had significant effect on migraine recurrence.