Transcatheter Closure And Recent Follow-Up Observation In Patients With Patent Foramen Ovale Combined With Cryptogenic Stroke And/or Migraine

OBJECTTVE:Evaluation of the safety,efficacy of transcatheter closure in patients with patent foramen ovale combined with cryptogenic stroke and/or migraine.And observation of postoperative recent residual shunt in patients with patent foramen ovale.METHODS:A total of 47 pantients with patent foramen ovale combined with cryptogenic stroke and/or migraine were selected in the Guangxi Zhuang Autonomous Region People’s Hospital from January 2013 to January 2015,including 26 cases of cryptogenic stroke(5 patients with concomitant migraine),9 cases of transient cerebral ischemia,12 cases of pure migraine,all patients were performed transcatheter therapy, according contrast transthoracic echocardiography and contrast transcranial doppler to determine shape and size of PFO before operation,then according the results to select appropriate occluder,the contrast transthoracic echocardiography and the contrast transcranial doppler were examined after 1,3,6 months to understand the plugging effect, and record the follow-up symptoms,HIT-6 score was assessed before treatment and after 1,3,6 months of treatment in patients of migraine, all patients were examined head CT afte 6 months to see whether the new-onset cerebral lesions.RESULTS:A total of 47 pantients with patent foramen ovale combined with cryptogenie stroke and/or migraine(24males and23 females) aged 19-70 (48.47±13.77) years were enrolled in the study,contrast transcranial doppler preoperative detection right-to-left shunt volume,4 patients were Grade Ⅱ,10 patients were Grade Ⅲ,33 patients were Grade IV,47 patients were operated successfully. No complications occurred during hospitalization and follow-up. postoperative 1 month according to cTCD indicated 23 cases with residual shunts(Grade Ⅱ:21, Grade Ⅲ:1, Grade IV:1), postoperative 3 month 7 cases with residual shunts(Grade Ⅱ:7), postoperative 6 month 4 cases with residual shunts(Grade Ⅱ:4).All patients were gradually improved after closure,17 cases of migraine,whether migraine with aura or stroke, postoperative 1 month compared with preoperative HIT-6,postoperative 3 months compared with postoperative 1 month HIT-6 and postoperative 6 month compared with postoperative 3 month HIT-6,the differences were statistical significance (P< 0.05),show that symptoms had improved postoperative 1 month, and the impact on the quality of daily life over time is reduced,head CT showed that no patients had new ischemia lesion after 6 months.CONCLUSION:Patients with patent foramen ovale combined with cryptogenic stroke and/or migraine cured by interventional therapy is safe and effective,can significantly relieve migraine headache patients, effective in preventing recurrent stroke.However,it is necessary to pay attention to postoperative follow-up and review cTCD for postoperative residual shunt.And the long-term effect of treatment needs further observation.