| Objective:This study followed up and evaluated the remission degree and severity of migraine in patients with right-to-left shunt migraine after the occlusion of oval orifice and the use of conventional drugs.The purpose was to investigate the clinical efficacy and safety of PFO transcatheter closure treatment in patients who have migraine with right-to-left shunt(RLS),and to provide objective reference evidence for the treatment of migraine combined with right-to-left shunt.Methods:114 patients with migraine who were examined in neurology in our hospital from January 2016 to March 2017 were selected as subjects,all of which met the diagnostic criteria for the International Classification of Headache Disorders 3rd Edition Beta Version,ICHD-3β.The imaging examination was carried out by an experienced ultrasound physician,and the patients with right-to-left shunt were diagnosed by contrast-enhanced transcranial Doppler,transesophageal echocardiography or transthoracic echocardiography,and the shunt amount belonged to medium to large shunt.The 114patients diagnosed with right-to-left shunt and the indication of PFO transcatheter closure treatment were divided into operation Group(n=57)and control group(n=57)according to 1:1 proportion.There were 17 cases of males in the Operation Group,40 cases in women,age 34～65岁,1-24 years of disease,including 19 cases of migraine with aura,18 cases of hyperlipidemia,24 cases of hypertension,14 cases of diabetic.In the control group,20 cases were men,37 cases were female,age was 36～67岁,the course of disease was 1-23 years,including 21 cases of migraine with aura,16 cases of hyperlipidemia,22 cases of hypertension and 16 cases of diabetes mellitus.The operation group was treated with PFO transcatheter closure treatment,and the control group was treated with drugs.The primary endpoint were the headache-impact-test score(HIT-6)at one year and the reduction in HIT-6 at one year compared to baseline.Adverse events were defined as perioperative complications at one month and one year,residual RLS at24 hours and one year,and new onset cerebrovascular events.Results:(1)The patients with migraine combined with right-to-left shunt treated with 114cases of PFO transcatheter closure treatment were successfully operated.(2)After one year,the HIT-6 grade was 49.57±4.58 and the difference value was 14.38±3.57 of the operated group,and the values were 56.85±5.69 and 8.64±2.24 in control group respectively.There had statistical significance of the difference between the two groups(P<0.05).(3)Postoperative complications occurred in 11 patients(19.3%)after one month of operation,including 5 cases(17.54%)patients with palpitations symptoms,3 cases(5.26%)with chest tightness symptoms,2 cases(3.51%)sensory limb weakness,1 cases(1.75%)had symptoms of conscious dyspnea.Complications disappeared on their own at1 years of follow-up after surgery.The results of c-TCD exploration after 24h showed that there were 8 cases(14.04%)of surgical patients with a large number of residual shunt,which was significantly reduced compared with before operation(x2=34.790,P<0.05).(4)In 1 years after operation,52 patients(including 8 patients with a large number of residual shunt after Operation 24h)were reviewed c-TCD,9(17.31%).There were residual shunt:a large number of residual shunt 1 cases(1.92%),medium residual shunt 3cases(5.77%),a small amount of residual shunt 5 cases(9.62%).(5)In 1 years,52patients in the surgical group and 50 patients in the control group reviewed the MRI of the brain.MRI results showed that there were 7 cases(13.46%)of new infarction lesions in the brain,and 17 cases(34%)of the brain showed new infarction lesions in the control group.The difference between the two groups was statistically significant(x~2=5.976,P<0.05).Conclusions:(1)PFO transcatheter closure treatment can effectively improve patients with migraine symptoms and reduce the risk of stroke.(2)The incidence of complications in PFO transcatheter closure treatment was low and the safety was high. |
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