| Objectives:The purpose of this study is to evaluate the efficacy and safety of transcatheter patent foramen ovale(PFO)closure in the treatment of migraine,to analyze whether there are differences in the degree of migraine and postoperative migraine improvement between intrinsic and potential shunts and between class III and class IV shunts,and to compare the differences in preoperative and postoperative platelet-related indexes to provide a basis for the treatment of migraine with patent foramen ovale closure.Methods:1.Prospective study: Patients diagnosed with migraine from January 2021 to December 2021 at the outpatient clinic of the Department of Neurology of the First Affiliated Hospital of Dalian Medical University,who were diagnosed by transthoracic echocardiography(TTE),contrast transthoracic echocardiography(c TTE),transesophageal echocardiography(TEE)and contrast-enhanced transcranial Doppler(c TCD)unclosed foramen ovale and massive shunts,and who were willing to undergo interventional occlusion for migraine.After blocking,the patients were followed up regularly by outpatient clinics,and cardiac ultrasound was performed at months 1,3,and 6 to assess cardiac structure and function,c TTE to assess residual right-to-left shunt(r RLS),HIT-6 score and NRS score to assess improvement of migraine,blood count to assess platelet variation,and other adverse events were recorded.38 patients were finally included in the study.2.Retrospective study: a retrospective analysis of patients with PFO combined with migraine treated with closure treatment in a large number of shunts diagnosed at the First Affiliated Hospital of Dalian Medical University from January 2021 to December 2021 was performed,and 39 patients were included.The effectiveness of PFO closure for migraine was evaluated by comparing the changes in patient migraine NRS scores preoperatively,in the first month postoperatively,and from 3-6 months.We also divided the 39 patients into the intrinsic group(right-to-left shunt at rest)and the potential group(right-to-left shunt after Valsalva maneuver)according to the preoperative c TTE results,and compared whether there was a difference between the two groups in terms of preoperative migraine level and postoperative migraine improvement;and compared the preoperative migraine level and postoperative migraine improvement between level III and level IV shunts according to the c TTE results.The differences in the preoperative migraine level and postoperative migraine improvement were compared between the two groups according to the c TTE results.Results:In a prospective study of 38 patients,23 patients had complete relief of migraine and 2 patients did not have any improvement in their migraine.All patients in this study had a moderate to large right-to-left shunt after preoperative c TTE for Valsalva maneuver,and the shunt flow at 6 months after blockade was mostly shifted toward no shunt and class I shunt,which was statistically different(p< 0.05).The patients’ preoperative and postoperative migraine NRS scores at month 1,month 3,and month 6 were 6.65 ±2.04,1.44± 2.04,1.43± 2.16,and 1.08±2.04,and HIT scores were 58.50± 7.59,24.21±25.19,23.29±3.75,18.64±24.93,compared with preoperative,NRS and HIT scores were significantly lower at postoperative month 1,month 3,and month 6,all with statistically different(p<0.05).The number of platelets,mean platelet volume(MPV),and platelet pressure volume measured on postoperative day 1 decreased and the mean platelet distribution width increased,all statistically different(p<0.05),and the ratio of MPV to large platelets decreased at postoperative months 1,3,and 6,all statistically different(p<0.05),compared with preoperative days.Cardiac ultrasonography suggested that the structure and function of the patient’s heart were not affected by the surgery.None of the patients had adverse events such as malignant arrhythmia,endocarditis,thrombosis,or dislodgement of the blocker at the 6-month postoperative follow-up.In a retrospective study of 39 patients,23 patients had complete relief of migraine and 4 patients had no improvement in self-reported migraine,with a preoperative NRS score of 8.41 1.83 and a statistically significant difference between the NRS scores of 3.21 ±3.79 and 2.90±3.57 in the first postoperative month and 3-6 months postoperatively,respectively(p< 0.05).There were 21 people in the intrinsic type group and 18 people in the potential type subgroup,and there was no significant difference in the degree of preoperative migraine and postoperative migraine improvement between the two groups.There were 25 in the fractional flow class III and 12 in the fractional flow class IV,and there was no significant difference between the two groups in the degree of preoperative migraine and the degree of postoperative migraine improvement..Conclusions:1.Transcatheter oval foramen occlusion can effectively improve migraine symptoms in patients,and is safe and reliable.2.There was no statistical difference in the effect of shunt type between intrinsic and potential type,and between shunt class III and class IV on the degree of migraine and postoperative migraine improvement.3.The mean volume of platelets and the ratio of large platelets decreased significantly after blockade compared with the preoperative period,which was statistically different. |
