ABSTRACT
Objective To investigate the effect of the transcatheter closure of patent foramen ovale (PFO) on the treatment of migraine.Methods This prospective clinical trial enrolled 43 consecutive migraine patients with PFO from Department of Neurology,Beijing Anzhen Hospital from March 2014 to March 2015,in which PFO was diagnosed by transesophageal echocardiography (TEE) and contrast-enhanced transcranial Doppler (c-TCD).We grouped subjects according to their selection or refusal of PFO closure.Nine patients were allocated to treatment with PFO closure.Thirty-four patients were given with medical treatment and were assigned to control group.Basal clinical data,frequency of migraine,duration of migraine and scores of Headache Impact Test-6 (HIT-6) were collected.c-TCD was performed after procedure of PFO closure transthoracic echocardiography.Changes of HIT-6 scores were analyzed after closure of PFO in the follow-up period.Results Successful PFO procedure was achieved in all patients without any complications both in hospital and in follow-up period.Only one patient had residual Ⅱ-grade right-to-left shunt (RLS) tested by c-TCD.Mean scores of HIT-6 in the surgical group were reduced significantly (49.3 ± 3.6 vs 67.5 ± 4.9,t =15.129,P =0.000).There were statistically significant differences in mean reduction of HIT-6 scores in the following one year for the female (48.8 ± 3.1 vs 69.8 ± 2.6,t =15.674,P=0.002),constant RLS (47.8 ±2.1 vs 67.9 ±3.5,t =8.572,P=0.043),RLS Ⅲ (50.6±2.3 vs65.4±2.7,t=7.663,P=0.039)/RLS 1V(48.2 ±1.9 vs 68.5 ±3.9,t=8.924,P=0.028)as well as migraine with aura subgroup (47.9± 1.6 vs 68.3 ±3.8,t=13.532,P=0.001).Conclusion Our results suggest that transcatheter PFO closure is a safe and effective approach for the treatment of migraine,espeecially for female migraineur with aura and with constant serious RLS.
ABSTRACT
OBJECTIVE:To compare the incidence of cerebral events in patients with ischemic cerebrovascular disease compli-cating with cerebral microbleeds(CMBs)at the last stage of antiplatelet agent use. METHODS:140 patients with ischemic cerebro-vascular disease were selected from Beijing Anzhen Hospital Affilicated to Capital Medical University during Jan. 2013-Jan. 2014, and then divided into CMBs group and non-CMBs group according to whether complicated with CMBs,with 70 cases in each group. After followed up for 1 year(regular use of aspirin 100 mg/d and/or clopidogrel 75 mg/d),the incidence of recurrent cere-bral infarction and cerebral bleeding and mortality were compared. RESUTLS:The incidence of recurrent cerebral infarction was 12.9% in CMBs group and 8.6% in non-CMBs group,without statistical significance(P=0.412);the incidence of cerebral bleed-ing was 10.0% in CMBs group and 1.4% in non-CMBs group,with statistical significance(P=0.029);the mortality of cerebro-vascular event at the last stage was 5.7% in CMBs group and 4.3% in non-CMBs group,without statistical significance (P=0.698). CONCLUSIONS:The risk of cerebral bleeding increase in patients with ischemic cerebrovascular disease complicating with CMBs after the application of antiplatelet agent. For patients with ischemic cerebrovascular disease complicating with CMBs,the application of antiplatelet agent should be based on the complete judgment and weighing of benefit and bleeding risk.