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이필형
이필형 (Pil Hyung Lee) 저자 이메일 보기
울산대학교 의과대학, 서울아산병원
 
조회 211  인쇄하기 주소복사 트위터 공유 페이스북 공유 
Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial
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Abstract

Background
Recent reports showing the favorable role of patent foramen ovale (PFO) closure in patients with cryptogenic stroke have raised the issue of selecting optimal candidates.

Objectives
This study, DEFENSE-PFO (Device Closure Versus Medical Therapy for Cryptogenic Stroke Patients With High-Risk Patent Foramen Ovale), evaluated whether the benefits of PFO closure can be determined on the basis of the morphologic characteristics of the PFO, as evaluated by transesophageal echocardiography.

Methods
Patients with cryptogenic stroke and high-risk PFO were divided between a transcatheter PFO closure and a medication-only group. High-risk PFO included PFO with atrial septal aneurysm, hypermobility (phasic septal excursion into either atrium ≥10 mm), or PFO size (maximum separation of the septum primum from the secundum) ≥2 mm. The primary endpoint was a composite of stroke, vascular death, or Thrombolysis In Myocardial Infarction–defined major bleeding during 2 years of follow-up.

Results
From September 2011 until October 2017, 120 patients (mean age: 51.8 years) underwent randomization. PFO size, frequency of septal aneurysm (13.3% vs. 8.3%; p = 0.56), and hypermobility (45.0% vs. 46.7%; p > 0.99) were similar between the groups. All PFO closures were successful. The primary endpoint occurred exclusively in the medication-only group (6 of 60 patients; 2-year event rate: 12.9% [log-rank p = 0.013]; 2-year rate of ischemic stroke: 10.5% [p = 0.023]). The events in the medication-only group included ischemic stroke (n = 5), cerebral hemorrhage (n = 1), Thrombolysis In Myocardial Infarction–defined major bleeding (n = 2), and transient ischemic attack (n = 1). Nonfatal procedural complications included development of atrial fibrillation (n = 2), pericardial effusion (n = 1), and pseudoaneurysm (n = 1).

Conclusions
PFO closure in patients with high-risk PFO characteristics resulted in a lower rate of the primary endpoint as well as stroke recurrence. (Device Closure Versus Medical Therapy for Cryptogenic Stroke Patients With High-Risk Patent Foramen Ovale [DEFENSE-PFO]; NCT01550588)

Key Words : cryptogenic stroke; echocardiography; patent foramen ovale

논문정보
- 형식: Research article
- 게재일: 2018년 05월 (BRIC 등록일 2018-07-02)
- 연구진: 국내연구진태극기
- 분야: Medicine
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권오성 (울산대학교 의과대학, 서울...)
박덕우 (울산의대, 서울아산병원)
박승정 (울산의대, 서울아산병원)
송재관 (울산의대)
이승환 (서울아산병원)
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Medicine

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프리미엄 Bio일정 Bio일정 프리미엄 안내
제2회 오가노이드 심포지엄 및 핸즈온워크샵 [2019 CHA Organoid Center Symposium]
제2회 오가노이드 심포지엄 및 핸즈온워크샵 [2019 CHA Organoid Center Symposium]
날짜: 2019.05.09
장소: 판교 차바이오컴플렉스 국제회의실
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