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Offenes Foramen ovale, Vorhofseptumaneurysma und Hirninfarkt

Übersicht über die bisherige Evidenzlage

Patent foramen ovale, atrial septum aneurysm, and stroke

A current examination of risk evidence

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Zusammenfassung

Die Frage der Kausalität eines offenen Foramen ovale bei ischämischem Schlaganfall sowie der optimalen Sekundärprävention dieser Patienten wird derzeit kontrovers diskutiert. Die beste verfügbare Evidenz stammt aus Fall-Kontroll-Studien, die in ihrer Gesamtheit auf einen Zusammenhang hindeuten, diesen aber letztlich nicht beweisen können. Neben paradoxen Embolien sind andere Pathomechanismen denkbar, deren genauer Nachweis in der Praxis jedoch nur selten gelingt. Bei niedrigem Rezidivrisiko zumindest für jüngere Patienten kann bei der momentanen Studienlage keine evidenzbasierte Empfehlung zur Sekundärprävention gegeben werden. Mehrere derzeit laufende randomisierte Studien sollen hier in einigen Jahren Klärung bringen. Primäres und sekundäres Risiko erscheinen jedoch deutlich erhöht bei begleitendem Vorhofseptumaneurysma. Zur weiteren Risikostratifizierung sollte der Einfluss begleitender Faktoren wie Shuntgröße und Gerinnungsstörungen weiter untersucht werden.

Summary

The role of a patent foramen ovale (PFO) in stroke is still regarded as controversial, as is the optimal strategy of secondary prevention for such patients. The best available evidence is derived from case-control studies, which in all show a statistically significant relationship but cannot be judged as conclusive for methodologic reasons. Besides paradoxic embolism, different pathomechanisms of stroke due to abnormalities of the atrial septum are possible that can rarely be verified in clinical routine. While the risk of stroke recurrence seems to be low at least for younger patients, to date no definite recommendations for secondary prevention can be given. Several ongoing randomized clinical trials might increase the store of evidence in this topic over the next years. However, primary and secondary risk seem to be substantially increased for the combined defect of PFO and atrial septum aneurysm. To allow further risk stratification, other potentially important factors such as shunt size and coagulation disorders should be targeted in future studies.

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Danksagung

Der Studienverbund Schlaganfall wurde von 2000–2002 im Rahmen des Kompetenznetzes Schlaganfall vom Bundesministerium für Bildung und Forschung gefördert. Seit 2003 erfolgt eine Förderung durch die Deutsche Forschungsgemeinschaft (DI 327/8-1).

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Authors and Affiliations

  1. Neurologische Klinik, Universität Duisburg-Essen

    K. Kraywinkel, H.-C. Diener & C. Weimar

  2. Neurologische Klinik, Universität Gießen

    M. Jauss

  3. Institut für Epidemiologie und Sozialmedizin am Universitätsklinikum Münster, Domagkstraße 3, 48149, Münster, Deutschland

    K. Kraywinkel

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  1. K. Kraywinkel
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  2. M. Jauss
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  3. H.-C. Diener
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  4. C. Weimar
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Correspondence to K. Kraywinkel.

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Kraywinkel, K., Jauss, M., Diener, HC. et al. Offenes Foramen ovale, Vorhofseptumaneurysma und Hirninfarkt. Nervenarzt 76, 935–942 (2005). https://doi.org/10.1007/s00115-004-1874-5

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