Открытое овальное окно как причина рецидивирующих эмболических инсультов. Клиническое наблюдение - Журнал Терапевтический архив №9 Вопросы кардиологии 2022

Открытое овальное окно как причина рецидивирующих эмболических инсультов. Клиническое наблюдение

Комаров А.Л., Кривошеева Е.Н., Макеев М.И., Меркулов Е.В., Трипотень М.И., Панченко Е.П. Открытое овальное окно как причина рецидивирующих эмболических инсультов. Клиническое наблюдение. Терапевтический архив. 2022;94(9):1109–1114. DOI: 10.26442/00403660.2022.09.201842

© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.

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Komarov AL, Krivosheeva EN, Makeev MI, Merkulov EV, Tripoten MI, Panchenko EP. Patent foramen ovale as the cause of recurrent embolic strokes. Case report. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(9):1109–1114.
DOI: 10.26442/00403660.2022.09.201842

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Аннотация

Представлен клинический разбор пациентки молодого возраста с рецидивирующими ишемическими инсультами. Обсуждаются проблемы диагностики эмболических инсультов. Изложена методика обнаружения пациентов, у которых открытое овальное окно является наиболее вероятной причиной эмболического инсульта, в том числе подробно рассмотрены возможности визуализирующих методов диагностики. Освещена гипотеза возможного источника кардиоэмболии при открытом овальном окне. Даны рекомендации по вторичной профилактике ишемического инсульта, ассоциированного с открытым овальным окном. Рассматриваются вопросы антитромботического лечения.

Ключевые слова: открытое овальное окно, рецидивирующие эмболические инсульты, визуализирующие методы диагностики, антитромботическое лечение

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А clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. Detailed consideration of imaging diagnostic methods possibility is included. Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.

Keywords: patent foramen ovale, recurrent embolic strokes, imaging diagnostic methods, antithrombotic treatment

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Список литературы

1. Béjot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. La Presse Médicale. 2016;45(12):e391-8. DOI:10.1016/j.lpm.2016.10.003
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4. Adams H, Bendixen B, Kappelle L, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41. DOI:10.1161/01.str.24.1.35
5. Kleindorfer D, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467. DOI:10.1161/str.0000000000000375
6. Hart R, Diener H, Coutts S, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurology. 2014;13(4):429-38.
DOI:10.1016/s1474-4422(13)70310-7
7. Ntaios G, Perlepe K, Lambrou D, et al. Prevalence and Overlap of Potential Embolic Sources in Patients With Embolic Stroke of Undetermined Source. J Am Heart Assoc. 2019;8(15):e012858. DOI:10.1161/jaha.119.012858
8. Ahmed N, Audebert H, Turc G, et al. Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11–13 November 2018. Eur Stroke J. 2019;4(4):307-17. DOI:10.1177/2396987319863606
9. Hart R, Catanese L, Perera K, et al. Embolic Stroke of Undetermined Source. Stroke. 2017;48(4):867-72. DOI:10.1161/strokeaha.116.016414
10. Hart R, Sharma M, Mundl H, et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N Engl J Med. 2018;378(23):2191-201. DOI:10.1056/nejmoa1802686
11 Ntaios G, Papavasileiou V, Milionis H, et al. Embolic Strokes of Undetermined Source in the Athens Stroke Registry. Stroke. 2015;46(8):2087-93. DOI:10.1161/strokeaha.115.009334
12. Diener H, Sacco R, Easton J, et al. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N Engl J Med. 2019;380(20):1906-17. DOI:10.1056/nejmoa1813959
13. Toyoda K, Uchiyama S, Hagihara Y, et al. Dabigatran vs. Aspirin for Secondary Prevention After Embolic Stroke of Undetermined Source – Japanese Subanalysis of the RE-SPECT ESUS Randomized Controlled Trial. Circ J. 2020;84(12):2286-95. DOI:10.1253/circj.CJ-20-0563
14. Healey J, Gladstone D, Swaminathan B, et al. Recurrent Stroke With Rivaroxaban Compared With Aspirin According to Predictors of Atrial Fibrillation. JAMA Neurol. 2019;76(7):764-73. DOI:10.1001/jamaneurol.2019.0617
15. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;42(5):373-498. DOI:10.1093/eurheartj/ehaa612
16. Schnabel R, Haeusler K, Healey J, et al. Searching for Atrial Fibrillation Poststroke. Circulation. 2019;140(22):1834-50. DOI:10.1161/circulationaha.119.040267
17. Kasner S, Swaminathan B, Lavados P, et al. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial. Lancet Neurol. 2018;17(12):1053-60. DOI:10.1016/s1474-4422(18)30319-3
18. Mojadidi M, Winoker J, Roberts S, et al. Accuracy of Conventional Transthoracic Echocardiography for the Diagnosis of Intracardiac Right-to-Left Shunt: A Meta-Analysis of Prospective Studies. Echocardiography. 2014;31(9):1036-48. DOI:10.1111/echo.12583
19. Schnabel R, Camen S, Knebel F, et al. Expert opinion paper on cardiac imaging after ischemic stroke. Clin Res Cardiol. 2021;110(7):938-58. DOI:10.1007/s00392-021-01834-x
20. Pristipino C, Sievert H, D'Ascenzo F, et al. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. Eurointervention. 2019;14(13):1389-402. DOI:10.4244/eij-d-18-00622
21. Giblett J, Williams L, Kyranis S, et al. Patent Foramen Ovale Closure: State of the Art. Interventional. Interv Cardiol. 2020;15:e15. DOI:10.15420/icr.2019.27
22. Kent D, Ruthazer R, Weimar C, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013;81(7):619-25. DOI:10.1212/wnl.0b013e3182a08d59
23. Kent D, Saver J, Ruthazer R, et al. Risk of Paradoxical Embolism (RoPE) – Estimated Attributable Fraction Correlates With the Benefit of Patent Foramen Ovale Closure. Stroke. 2020;51(10):3119-23. DOI:10.1161/strokeaha.120.029350
24. Mojadidi M, Bogush N, Caceres J, et al. Diagnostic Accuracy of Transesophageal Echocardiogram for the Detection of Patent Foramen Ovale: A Meta-Analysis. Echocardiography. 2013;31(6):752-8. DOI:10.1111/echo.12462
25. Mojadidi M, Roberts S, Winoker J, et al. Accuracy of Transcranial Doppler for the Diagnosis of Intracardiac Right-to-Left Shunt. JACC Cardiovascular Imaging. 2014;7(3):236-50. DOI:10.1016/j.jcmg.2013.12.011
26. Yan C, Li H. Preliminary Investigation of In situ Thrombus Within Patent Foramen Ovale in Patients With and Without Stroke. JAMA. 2021;325(20):2116. DOI:10.1001/jama.2021.4359
27. Hakeem A, Cilingiroglu M, Katramados A, et al. Transcatheter closure of patent foramen ovale for secondary prevention of ischemic stroke: Quantitative synthesis of pooled randomized trial data. Catheter Cardiovasc Interv. 2018;92(6):1153-60. DOI:10.1002/ccd.27487
28. Turc G, Calvet D, Guérin P, et al. Closure, Anticoagulation, or Antiplatelet Therapy for Cryptogenic Stroke With Patent Foramen Ovale: Systematic Review of Randomized Trials, Sequential Meta-Analysis, and New Insights From the CLOSE Study. J Am Heart Assoc. 2018;7(12):e008356. DOI:10.1161/jaha.117.008356

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1. Béjot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. La Presse Médicale. 2016;45(12):e391-8. DOI:10.1016/j.lpm.2016.10.003
2. Virani S, Alonso A, Benjamin E, et al. Heart Disease and Stroke Statistics – 2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-596. DOI:10.1161/cir.0000000000000757
3. Akzhigitov RG, Alekian BG, Alferova VV, et al. Klinicheskie rekomendatsii. Ishemicheskii insul't i tranzitornaia ishemicheskaia ataka u vzroslykh. Moscow: Atomizdat, 2021. Available at: https://www.neurology.ru/klinicheskie-rekomendacii-ishemicheskiy-insult-i-tranzitornaya-ishemicheska.... Accessed: 11.09.2022 (in Russian).
4. Adams H, Bendixen B, Kappelle L, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41. DOI:10.1161/01.str.24.1.35
5. Kleindorfer D, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467. DOI:10.1161/str.0000000000000375
6. Hart R, Diener H, Coutts S, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurology. 2014;13(4):429-38.
DOI:10.1016/s1474-4422(13)70310-7
7. Ntaios G, Perlepe K, Lambrou D, et al. Prevalence and Overlap of Potential Embolic Sources in Patients With Embolic Stroke of Undetermined Source. J Am Heart Assoc. 2019;8(15):e012858. DOI:10.1161/jaha.119.012858
8. Ahmed N, Audebert H, Turc G, et al. Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11–13 November 2018. Eur Stroke J. 2019;4(4):307-17. DOI:10.1177/2396987319863606
9. Hart R, Catanese L, Perera K, et al. Embolic Stroke of Undetermined Source. Stroke. 2017;48(4):867-72. DOI:10.1161/strokeaha.116.016414
10. Hart R, Sharma M, Mundl H, et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N Engl J Med. 2018;378(23):2191-201. DOI:10.1056/nejmoa1802686
11 Ntaios G, Papavasileiou V, Milionis H, et al. Embolic Strokes of Undetermined Source in the Athens Stroke Registry. Stroke. 2015;46(8):2087-93. DOI:10.1161/strokeaha.115.009334
12. Diener H, Sacco R, Easton J, et al. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N Engl J Med. 2019;380(20):1906-17. DOI:10.1056/nejmoa1813959
13. Toyoda K, Uchiyama S, Hagihara Y, et al. Dabigatran vs. Aspirin for Secondary Prevention After Embolic Stroke of Undetermined Source – Japanese Subanalysis of the RE-SPECT ESUS Randomized Controlled Trial. Circ J. 2020;84(12):2286-95. DOI:10.1253/circj.CJ-20-0563
14. Healey J, Gladstone D, Swaminathan B, et al. Recurrent Stroke With Rivaroxaban Compared With Aspirin According to Predictors of Atrial Fibrillation. JAMA Neurol. 2019;76(7):764-73. DOI:10.1001/jamaneurol.2019.0617
15. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;42(5):373-498. DOI:10.1093/eurheartj/ehaa612
16. Schnabel R, Haeusler K, Healey J, et al. Searching for Atrial Fibrillation Poststroke. Circulation. 2019;140(22):1834-50. DOI:10.1161/circulationaha.119.040267
17. Kasner S, Swaminathan B, Lavados P, et al. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial. Lancet Neurol. 2018;17(12):1053-60. DOI:10.1016/s1474-4422(18)30319-3
18. Mojadidi M, Winoker J, Roberts S, et al. Accuracy of Conventional Transthoracic Echocardiography for the Diagnosis of Intracardiac Right-to-Left Shunt: A Meta-Analysis of Prospective Studies. Echocardiography. 2014;31(9):1036-48. DOI:10.1111/echo.12583
19. Schnabel R, Camen S, Knebel F, et al. Expert opinion paper on cardiac imaging after ischemic stroke. Clin Res Cardiol. 2021;110(7):938-58. DOI:10.1007/s00392-021-01834-x
20. Pristipino C, Sievert H, D'Ascenzo F, et al. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. Eurointervention. 2019;14(13):1389-402. DOI:10.4244/eij-d-18-00622
21. Giblett J, Williams L, Kyranis S, et al. Patent Foramen Ovale Closure: State of the Art. Interventional. Interv Cardiol. 2020;15:e15. DOI:10.15420/icr.2019.27
22. Kent D, Ruthazer R, Weimar C, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013;81(7):619-25. DOI:10.1212/wnl.0b013e3182a08d59
23. Kent D, Saver J, Ruthazer R, et al. Risk of Paradoxical Embolism (RoPE) – Estimated Attributable Fraction Correlates With the Benefit of Patent Foramen Ovale Closure. Stroke. 2020;51(10):3119-23. DOI:10.1161/strokeaha.120.029350
24. Mojadidi M, Bogush N, Caceres J, et al. Diagnostic Accuracy of Transesophageal Echocardiogram for the Detection of Patent Foramen Ovale: A Meta-Analysis. Echocardiography. 2013;31(6):752-8. DOI:10.1111/echo.12462
25. Mojadidi M, Roberts S, Winoker J, et al. Accuracy of Transcranial Doppler for the Diagnosis of Intracardiac Right-to-Left Shunt. JACC Cardiovascular Imaging. 2014;7(3):236-50. DOI:10.1016/j.jcmg.2013.12.011
26. Yan C, Li H. Preliminary Investigation of In situ Thrombus Within Patent Foramen Ovale in Patients With and Without Stroke. JAMA. 2021;325(20):2116. DOI:10.1001/jama.2021.4359
27. Hakeem A, Cilingiroglu M, Katramados A, et al. Transcatheter closure of patent foramen ovale for secondary prevention of ischemic stroke: Quantitative synthesis of pooled randomized trial data. Catheter Cardiovasc Interv. 2018;92(6):1153-60. DOI:10.1002/ccd.27487
28. Turc G, Calvet D, Guérin P, et al. Closure, Anticoagulation, or Antiplatelet Therapy for Cryptogenic Stroke With Patent Foramen Ovale: Systematic Review of Randomized Trials, Sequential Meta-Analysis, and New Insights From the CLOSE Study. J Am Heart Assoc. 2018;7(12):e008356. DOI:10.1161/jaha.117.008356

Авторы

А.Л. Комаров, Е.Н. Кривошеева*, М.И. Макеев, Е.В. Меркулов, М.И. Трипотень, Е.П. Панченко

ФГБУ «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Россия
*lena-4ka@yandex.ru

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Andrey L. Komarov, Elena N. Krivosheeva*, Maksim I. Makeev, Evgeny V. Merkulov, Maria I. Tripoten, Elizaveta P. Panchenko

Chazov National Medical Research Center of Cardiology, Moscow, Russia
*lena-4ka@yandex.ru

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