Comparison Of Interventional Closure And Drug Therapy For Patent Foramen Ovale With Cryptogenic Stroke

Objective Comparison of the secondary preventive effects of surgical treatment and drug therapy on patent foramen ovale(PFO)with cryptogenic stroke(CS).Methods A total of 219 patients with cerebral infarction or transient ischemic attack(TIA)combined with PFO admitted to the Department of Neurology of General Hospital of Ningxia Medical University from January 1,2015 to August 31,2019 were selected,among whom 3 patients were lost to follow-up,and a total of 216 patients were enrolled.In the first step,the patients were divided into young and middle-aged group(18-59 years old)and old group(≥60 years old)according to their age,and secondly,according to treatment methods,they were divided into operation group(PFO interventional closure+antiplatelet drugs)and drug group(oral antiplatelet or anticoagulant drugs only).A total of 167 cases in the young and middle-aged group were collected,including operation group(n=80)and drug group(n=87).The general data of different treatment methods in the young and middle-aged group were compared.Including age,sex,smoking,drinking,hypertension,diabetes,coronary heart disease,hyperlipidemia,hyperhomocysteinemia,migraine,deep venous thrombosis,obstructive sleep apnea(OSA),PFO size classification,antithrombotic drugs,recurrence of end events and analysis of factors affecting the recurrence of end events.According to the Kaplan-Meier survival curve,the effects of the two treatments on the survival of patients with no end events were compared.A total of 49 patients in the elderly group were collected,including operation group(n=17)and drug group(n=32).The analysis content of the elderly group was the same as that of the young and middle-aged group.Results For the young and middle-aged group,the recurrence rate of end-point events in the operation group was significantly lower than that in the drug group(χ~2=10.959,P=0.001),and the patients with moderate or large PFO shunt benefited more(χ~2=8.429,P=0.004).The young and middle-aged patients were divided into two groups according to the presence or absence of end-point events,and Cox regression analysis was performed.The results showed that for the young and middle-aged group,the recurrence rate of end point events in patients with PFO combined with CS in the drug group was higher,which was 4.809 times as high as that in the surgery group[95%CI(1.581,14.633)].The incidence of end-point events in CS patients with coexistence of PFO and OSA was 3.383times higher than that in patients without OSA history[(95%CI(1.356,8.440)].Kaplan-Meier survival curve showed that the survival status of patients with no end-point events in the operation group was better than that in the drug group.For the elderly group,there was no significant difference between the two treatments(χ~2=3.455,P=0.063).Conclusion 1.For the young and middle-aged group of patients with PFO complicated with CS,PFO interventional closure can reduce the risk of recurrence of terminal events,and patients with moderate or large PFO shunt benefit more.2.For the young and middle-aged group of patients with CS with coexistence of PFO and OSA,the risk of recurrence of end events is higher than that of patients without OSA history.3.For the elderly patients with PFO complicated with CS,there was no difference in secondary prevention of end events between surgical treatment and drug therapy.