Correlation Study Of Right To Left Shunt And Ischemic Cerebrovascular Disease

Background:Through the study right to left shunt (right-to-left shunt, RLS)incidence rate difference of patients with ischemic stroke and stroke freecontrols, and various comprehensive analysis of stroke risk factors, tostudy whether RLS is an independent risk factor for ischemic stroke.Method:According to the diagnostic criteria of ischemic cerebral strokerevised by the fourth national cerebrovascular conference, ischemicstroke patients and non stroke patients in the control group werecontinuously collected from2012January to2012December. Thestandard questionnaire of cerebral vascular disease risk factors isinvestigated,and transcranial Doppler ultrasound (transcranial Doppler,TCD), carotid artery ultrasound, TCD foaming test and head MRIexamination are carried out.283cases of patients with ischemic strokeand118cases of control group patients get in group after informedconsent. According to the TOAST classification,patients are divided intofive types: Large-artery atherosclerosis stroke(LAA), Small-arteryocclusion stroke or Lacunar stroke(SAA), Cardioembolism(CE),Stroke ofother determined etiology(SOE) and Stroke of other undetermined etiology(SUE). Classification according to the severity of RLS:severe(>30microembolic signals),moderate(10-30microembolic signals), mild(<10microembolic signals). Compare the incidence of PFO between thestroke group and control group, and analyse with other risk factors forstroke to find out whether RLS is an independent risk factor for ischemicstroke.Results:85cases out of283stroke patients have PFO,26patients out of118cases of the control group have PFO (30.0%vs.22.0%incidence, X2=2.67, P=0.10), multiple regression analysis of stroke risk factors showedOR=1.59, P=0.149, RLS cannot be established as an independent riskfactor for stroke.45cases out of134cases of patients with cryptogenic ischemicstroke have PFO, the incidence was33.6%, compared with the controlgroup P <0.05, X2=4.14, PFO was significantly associated withunexplained stroke. Multiple regression analysis of stroke risk factors forcryptogenic stroke group and control group, OR=2.18,95%CI1.05-4.51,P=0.036, PFO were the independent risk factors of cryptogenic stroke;Severe and moderate shunts have significant correlation with cryptogenicischemic stroke (OR=3.90,95%CI1.28-11.87, P=0.016and OR=3.35,95%CI1.01-11.07, P=0.048). Conclusion:RLS is the independent risk factors of cryptogenic stroke. Theseverity of RLS is more serious, the possibility of unexplained stroke willbe more.