Efficacy of interventional closure of patent foramen ovale in migraine patients with moderate right⁃to⁃left shunt
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摘要:
目的:通过对比介入封堵治疗偏头痛合并中、大量右向左分流(right-to-left shunt,RLS)卵圆孔未闭(patent foramen ovale,PFO)患者的手术难度与近期疗效,评价偏头痛伴中量RLS-PFO患者行介入封堵的可行性。方法:入选偏头痛合并中量或大量RLS-PFO并行介入封堵的患者95例,分析两组患者的偏头痛症状、封堵成功率、封堵难度、术后RLS量及术后头痛缓解水平的差异。结果:两组术前头痛影响测试-6(headache impact test-6,HIT-6)、偏头痛残疾评估量表(migraine disability as- sessment questionnaire,MIDAS)评分无统计学差异(P>0.05);两组封堵成功率无统计学差异(92.00% vs. 98.57%,P=0.137),但中量RLS-PFO组术中第2根导丝使用率、心腔内超声利用率及X线曝光时间明显高于大量RLS-PFO组(P<0.01);中量RLS- PFO组术后3 d有效封堵率高于大量RLS-PFO组(86.96% vs. 56.52%,P=0.008),两组间术后1个月、3个月、6个月RLS量及有效封堵率无统计学差异(P>0.05);两组患者术后6个月HIT-6和MIDAS评分较术前改善(P<0.001),但中量RLS-PFO组术后6个月HIT-6评分较大量RLS- PFO组下降(P=0.012),而MIDAS评分无统计学差异。结论:偏头痛合并中量RLS-PFO患者行介入封堵的手术难度较大量RLS- PFO高,但介入封堵后头痛缓解疗效两组相似。
Abstract:
Objective:To evaluate the feasibility of interventional closure in migraine patients with moderate right -to -left shunt patent foramen ovale(RLS-PFO)by comparing the surgical difficulty and short-term efficacy between patients with moderate or large RLS-PFO. Methods:A total of 95 patients with migraine accompanied by moderate or large RLS-PFO who underwent interventional closure were selected. The differences inmigraine symptoms,closure success rate,closure difficulty,postoperative RLS volume and postoperative headache relief level were analyzed. Results:There was no significant difference in preoperative headache impact test-6 (HIT-6)and migraine disability assessment questionnaire(MIDAS)scores between the two groups(P>0.05). There was no difference in closure success rate between the two groups(92.00% vs. 98.57%,P=0.137),but the usage rate of the second guidewire,intracardiac ultrasound utilization rate,and X-ray exposure time were significantly higher in the moderate RLS-PFO group than in the large RLS- PFO group(P < 0.01). The effective closure rate at 3 days after the procedure was higher in the moderate RLS-PFO group than in the large RLS-PFO group(86.96% vs. 56.52%,P=0.008),but there were no differences in RLS volume and effective closure rate at 1 month,3 months and 6 months after operation between the two groups(P>0.05). The HIT-6 and MIDAS scores were improved at 6 months after the procedure compared to before the procedure in both groups(P<0.001),but the decrease in HIT-6 score at 6 months after the procedure was smaller in the moderate RLS-PFO group than in the large RLS-PFO group(P=0.012),while there was no difference in MIDAS score. Conclusion:The surgical difficulty of interventional closure in migraine patients with moderate RLS-PFO is higher than in patients with large RLS-PFO,but the efficacy of headache relief after interventional closure is similar between the two groups.