Right-to-left Shunt And Subclinical Ischemic Brain Lesions In Chinese Migraineurs

Objective: Migraine is considered as a risk factor for subclinical brain ischemic lesions,and right-to-left shunt(RLS)is more common among migraineurs.This cross-sectional study assessed the association of RLS with the increased prevalence of subclinical ischemic brain lesions in migraineurs.Methods: We enrolled 334 migraineurs,who according with the migraine diagnostic criteria of ICHD III-?,from a multicentre study from June 2015 to August 2016.Participants were all evaluated using contrastenhanced transcranial Doppler,magnetic resonance imaging(MRI),and completed a questionnaire covering demographics,the main risk factors of vascular disease,and migraine status.RLS was classified into four grades(Grade 0 = Negative;Grade I = 1 ? microbubbles(MBs)? 10;Grade II = MBs > 10 and no curtain;Grade III = curtain).Silent brain ischemic infarctions(SBI)and white matter hyperintensities(WMHs)were evaluated on MRI.RLS was considered permanent if it occurred during rest,and latent if it only occurred after a VM.Results: Among the 334 subjects enrolled in our study,224 subjects had a RLS(mean age 42.49 ± 10.97 years;160 females)and 110 had no RLS(mean age 44.03 ± 10.12 years,81 females).Except that the prevalence of aura was higher in patients with RLS than in those without RLS(29.9% vs.17.3%,P = 0.013),there were no significant differences between the two groups.We found no significant differences between migraineurs with RLS and migraineurs without RLS in subclinical ischemic brain lesions.SBI and WMHs did not increase with the size of the RLS(P for trend for SBI = 0.066,P for trend for WMHs = 0.543).Furthermore,curtain RLS in migraineurs was a risk factor for the presence of SBI(P = 0.032,OR = 3.47;95%CI: 1.12-10.76).There was no association between RLS and the presence of WMHs.When comparing permanent RLS and latent RLS with the group without RLS,the incidence of SBI and WMHs were not statistically significantly different.Conclusion:(1)Overall,RLS is not associated with increased SBI or WMHs in migraineurs;(2)When RLS is presented as curtain pattern,it is likely to be a risk factor for SBIs in migraineurs;(3)RLS can not increase the incidence of WMHs in migraine patients.