Elevated risk of recurrent stroke in females after patent foramen ovale closure for cryptogenic stroke:A 4-year retrospective cohort study

XIAO Weiwei; LIU Feng; WAN Chen; XU Xiang; GAO Hao; LI Xiaolong; WEI Xin; SONG Zhiyuan; LI Huakang

doi:10.16016/j.2097-0927.202508075

您当前的位置：

首页 >

文章列表页 >

Elevated risk of recurrent stroke in females after patent foramen ovale closure for cryptogenic stroke:A 4-year retrospective cohort study

Clinical Medicine | 更新时间：2025-11-28

- Elevated risk of recurrent stroke in females after patent foramen ovale closure for cryptogenic stroke:A 4-year retrospective cohort study
- Journal of Army Medical University Vol. 47, Issue 22, Pages: 2805-2813(2025)
- 作者机构：
  
  1.陆军军医大学（第三军医大学）第一附属医院心血管内科，代谢生物钟与心血管疾病中心
  2.老年心脑血管病教育部重点实验室，重庆
- 作者简介：
  
  LIHuakang，E-mail：lihuakang1980@tmmu.edu.cn
- 基金信息：
  
  the Chongqing Health Appropriate Technology Promotion and Application Project(023jstg008)
- DOI：10.16016/j.2097-0927.202508075
  CLC： R181.23;R541.1;R743.33
- Received：24 August 2025，
  
  Revised：2025-11-10，
  
  Accepted：11 November 2025，
  
  Published：30 November 2025
- 稿件说明：
移动端阅览
肖巍巍，刘锋，万陈，等.女性隐源性卒中患者卵圆孔未闭封堵术后卒中复发风险存在升高趋势：一项随访4年的回顾性队列研究［J］.陆军军医大学学报，2025，47（22）：2805-2813.DOI：10.16016/j.2097-0927.202508075.

XIAO W W，LIU F，WAN C，et al.Elevated risk of recurrent stroke in females after patent foramen ovale closure for cryptogenic stroke：A 4-year retrospective cohort study［J］.J Army Med Univ，2025，47（22）：2805-2813.DOI：10.16016/j.2097-0927.202508075.
肖巍巍，刘锋，万陈，等.女性隐源性卒中患者卵圆孔未闭封堵术后卒中复发风险存在升高趋势：一项随访4年的回顾性队列研究［J］.陆军军医大学学报，2025，47（22）：2805-2813.DOI：10.16016/j.2097-0927.202508075. DOI：

XIAO W W，LIU F，WAN C，et al.Elevated risk of recurrent stroke in females after patent foramen ovale closure for cryptogenic stroke：A 4-year retrospective cohort study［J］.J Army Med Univ，2025，47（22）：2805-2813.DOI：10.16016/j.2097-0927.202508075. DOI：

摘要

目的

探讨性别对卵圆孔未闭（patent foramen ovale， PFO）合并脑梗死/短暂性脑缺血发作（transient ischemic attack， TIA）患者卵圆孔未闭封堵术预后的影响。

方法

采用回顾性队列研究，纳入2013年1月至2023年12月于陆军军医大学第一附属医院住院并行卵圆孔未闭封堵术的脑梗死或 TIA患者为研究对象。按性别进行分组，收集患者的资料，包括年龄、合并的基础疾病、反常栓塞风险评分（the Risk of Paradoxical Embolism Score， RoPE）评分、检验资料、经胸和经食道超声心动图结果等；术后随访中记录了器械相关血栓（device-related thrombosis， DRT）、卒中、出血和心房颤动等并发症。

结果

一共112例患者选入本研究，其中男性59例，女性53例，平均年龄42.47±12.35岁。女性术前RoPE评分显著高于男性（6.6±1.4

6.0±1.5，

=0.046），二者在梗死部位分布存在性别差异趋势（

²=10.25，

=0.006），男性更易发生后循环梗死。术中经胸超声测量显示，女性卵圆孔距主动脉根部距离显著大于男性（9.3±2.4

7.6±2.0，

0.001）。术后中位随访期4年，男性组发生心肌梗死1例、脑出血1例、阵发性心房颤动1例、牙龈出血2例、皮肤淤青1例；女性组发生肺栓塞1例、阵发性心房颤动1例、牙龈出血3例、皮肤淤青2例、脑梗死复发2例、TIA复发2例。总体不良事件发生率方面二者无统计学差异（

=0.291），女性组在脑梗死和TIA复发率方面高于男性，但二者相比无统计学差异（

=0.222）。通过多因素Cox回归分析，并在校正了包括RoPE评分、年龄、高血压、冠心病等多种潜在混杂因素后，本研究结果表明，性别并非患者术后复合终末事件的独立预测因素。

结论

PFO合并脑梗死/TIA患者行卵圆孔未闭封堵术对预后的影响无性别差异，但是女性在脑梗死及TIA复发方面较男性有增加趋势。

Abstract

Objective

To investigate the effect of gender on prognosis after transcatheter patent foramen ovale (PFO) closure in patients with cerebral infarction or transient ischemic attack.

Methods

A retrospective cohort study was conducted involving patients with cerebral infarction or transient ischemic attack (TIA) who underwent PFO closure at our hospital between January 2013 and December 2023. The patients were grouped by gender

and related data were collected

including age

comorbidities

Risk of Paradoxical Embolism (RoPE) score

laboratory results

findings of transthoracic/transesophageal echocardiography (TTE/TEE)

and post-procedural complications

such as device-related thrombosis (DRT)

recurrent stroke

bleeding

and atrial fibrillation (AF).

Results

A total of 112 patients were enrolled

including 59 males and 53 females

at a mean age of 42.47±12.35 years. The females had significantly higher preoperative RoPE score than the males (6.6±1.4

6.0±1.5

=0.046)

and a statistical difference was observed in the distribution of infarction sites between them (

Chi

-square=10.25

=0.006)

indicating that the males were prone to posterior circulation infarction. Intraoperative transthoracic echocardiography revealed a greater distance from the PFO to the aortic root in the females (9.3±2.4 mm

7.6±2.0 mm

0.001). During a median follow-up of 4 years

the male group had 1 case of myocardial infarction

1 cerebral hemorrhage

1 paroxysmal AF

2 gingival bleeding episodes

and 1 skin ecchymosis. In the female group

1 case experienced pulmonary embolism

1 paroxysmal atrial fibrillation

3 gingival bleeding episodes

2 skin ecchymoses

2 recurrent cerebral infarctions

and 2 recurrent TIAs. There was no statistical difference in overall adverse events between gender (

=0.291). Although the females had higher rates of recurrent cerebral infarction and TIA

this difference lacked statistical significance (

=0.222). Multivariate Cox regressio

n analysis indicated that after adjusting for various potential confounding factors

such as RoPE score

age

hypertension

coronary heart disease

and other factors

gender was not an independent predictor of composite endpoint events after surgery.

Conclusion

Gender does not significantly affect overall prognosis after PFO closure in patients with cerebral infarction or TIA. However

females showed a trend toward higher rates of recurrent cerebral infarction and TIA.

关键词

Keywords

references

MAC GRORY B ， OHMAN E M ， FENG W W ， et al . Advances in the management of cardioembolic stroke associated with patent foramen ovale ［J］. Br Med J ， 2022 ， 376 ： e063161 . DOI： 10.1136/bmj-2020-063161 http://dx.doi.org/10.1136/bmj-2020-063161 .

MEIER B ， FRANK B ， WAHL A ， et al . Secondary stroke prevention： patent foramen ovale， aortic plaque， and carotid stenosis ［J］. Eur Heart J ， 2012 ， 33 （ 6 ）： 705 - 713 ， 713 a， 713b . DOI： 10.1093/eurheartj/ehr443 http://dx.doi.org/10.1093/eurheartj/ehr443 .

LAMY C ， GIANNESINI C ， ZUBER M ， et al . Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale： the PFO-ASA Study. Atrial Septal Aneurysm ［J］. Stroke ， 2002 ， 33 （ 3 ）： 706 - 711 . DOI： 10.1161/hs0302.104543 http://dx.doi.org/10.1161/hs0302.104543 .

KAVINSKY C J ， SZERLIP M ， GOLDSWEIG A M ， et al . SCAI guidelines for the management of patent foramen ovale ［J］. J Soc Cardiovasc Angiogr Interv ， 2022 ， 1 （ 4 ）： 100039 . DOI： 10.1016/j.jscai.2022.100039 http://dx.doi.org/10.1016/j.jscai.2022.100039 .

STORTECKY S ， DA COSTA B R ， MATTLE H P ， et al . Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism： a network meta-analysis ［J］. Eur Heart J ， 2015 ， 36 （ 2 ）： 120 - 128 . DOI： 10.1093/eurheartj/ehu292 http://dx.doi.org/10.1093/eurheartj/ehu292 .

LI W Y ， ZHANG J J ， ZHANG Y E ， et al . Clinical research progress on pathogenesis and treatment of Patent Foramen Ovale-associated stroke ［J］. Front Neurol ， 2025 ， 16 ： 1512399 . DOI： 10.3389/fneur.2025.1512399 http://dx.doi.org/10.3389/fneur.2025.1512399 .

ALMEIDA MORAIS L ， DE SOUSA L ， FIARRESGA A ， et al . RoPE score as a predictor of recurrent ischemic events after percutaneous patent foramen ovale closure ［J］. Int Heart J ， 2018 ， 59 （ 6 ）： 1327 - 1332 . DOI： 10.1536/ihj.17-489 http://dx.doi.org/10.1536/ihj.17-489 .

LEE P H ， SONG J K ， KIM J S ， et al . Cryptogenic stroke and high-risk patent foramen ovale ［J］. J Am Coll Cardiol ， 2018 ， 71 （ 20 ）： 2335 - 2342 . DOI： 10.1016/j.jacc.2018.02.046 http://dx.doi.org/10.1016/j.jacc.2018.02.046 .

GASPARDONE C ， TRABATTONI D ， D’ATRI D O ， et al . 15-year outcomes of PFO closure in patients with cryptogenic embolism： insights from the PROLONG registry ［J］. JACC Cardiovasc Interv ， 2025 ， 18 （ 12 ）： 1526 - 1537 . DOI： 10.1016/j.jcin.2025.04.041 http://dx.doi.org/10.1016/j.jcin.2025.04.041 .

中华医学会心血管病学分会，中华心血管病杂志编辑委员会 . 卵圆孔未闭规范化诊疗中国专家共识［J］. 中华心血管病杂志， 2024 ， 52 （ 4 ）： 369 - 383 . DOI： 10.3760/cma.j.cn112148-20231030-00393 http://dx.doi.org/10.3760/cma.j.cn112148-20231030-00393 .

Chinese Society of Cardiology of Chinese Medical Association ， Editorial Board of Chinese Journal of Cardiology . Chinese expert consensus on the standardized diagnosis and treatment of patent foramen ovale ［J］. Chin J Cardiol ， 2024 ， 52 （ 4 ）： 369 - 383 . DOI： 10.3760/cma.j.cn112148-20231030-00393 http://dx.doi.org/10.3760/cma.j.cn112148-20231030-00393 .

刘力萍，许祥，万陈，等 . 性别对行左心耳封堵术的心房颤动患者预后的影响［J］. 陆军军医大学学报， 2024 ， 46 （ 15 ）： 1797 - 1802 . DOI： 10.16016/j.2097-0927.202311122 http://dx.doi.org/10.16016/j.2097-0927.202311122 .

LIU L P ， XU X ， WAN C ， et al . Influence of gender on prognosis of atrial fibrillation patients after left atrial appendage occlusion ［J］. J Army Med Univ ， 2024 ， 46 （ 15 ）： 1797 - 1802 . DOI： 10.16016/j.2097-0927.202311122 http://dx.doi.org/10.16016/j.2097-0927.202311122 .

ZHANG XL ， KANG LN ， WANG L ， et al . Percutaneous closure versus medical therapy for stroke with patent foramen Ovale： a systematic review and meta-analysis ［J］. BMC Cardiovasc Disord ， 2018 ， 18 （ 1 ）： 45 . DOI： 10.1186/s12872-018-0780-x http://dx.doi.org/10.1186/s12872-018-0780-x .

兰春伟，刘涛，袁昆雄，等 . 不同年龄段隐源性脑梗死患者卵圆孔未闭情况调查分析［J］. 湖北科技学院学报（医学版）， 2020 ， 34 （ 2 ）： 105 - 108 . DOI： 10.16751/j.cnki.2095-4646.2020.02.0105 http://dx.doi.org/10.16751/j.cnki.2095-4646.2020.02.0105 .

LAN C W ， LIU T ， YUAN K X ， et al . Investigation and analysis of patent foramen ovale in cryptogenic cerebral infarction patients with different age groups ［J］. J Hubei Univ Sci Technol Med Sci ， 2020 ， 34 （ 2 ）： 105 - 108 . DOI： 10.16751/j.cnki.2095-4646.2020.02.0105 http://dx.doi.org/10.16751/j.cnki.2095-4646.2020.02.0105 .

张学谦，李阳，徐国栋，等 . 卵圆孔未闭所致急性脑梗死患者人口学特征、临床及影像学等特征分析［J］. 临床荟萃， 2023 ， 38 （ 6 ）： 500 - 503 . DOI： 10.3969/j.issn.1004-583X.2023.06.003. ZHANG X Q http://dx.doi.org/10.3969/j.issn.1004-583X.2023.06.003.ZHANGXQ ，

LI Y ， XU G D ， et al . Analysis of demographic， clinical and imaging in patients with acute cerebral infarction caused by patent foramen ovale ［J］. Clin Focus ， 2023 ， 38 （ 6 ）： 500 - 503 . DOI： 10.3969/j.issn.1004-583X.2023.06.003 http://dx.doi.org/10.3969/j.issn.1004-583X.2023.06.003 .

FARJAT-PASOS J I ， GUEDENEY P ， HOUDE C ， et al . Sex differences in patients with cryptogenic cerebrovascular events undergoing transcatheter closure of patent foramen ovale ［J］. J Am Heart Assoc ， 2023 ， 12 （ 19 ）： e030359 . DOI： 10.1161/JAHA.123.030359 http://dx.doi.org/10.1161/JAHA.123.030359 .

ASGHAR A ， STEFANESCU SCHMIDT A C ， SAHAKYAN Y ， et al . Sex differences in baseline profiles and short-term outcomes in patients undergoing closure of patent foramen ovale ［J］. Am Heart J Plus ， 2022 ， 21 ： 100199 . DOI： 10.1016/j.ahjo.2022.100199 http://dx.doi.org/10.1016/j.ahjo.2022.100199 .

张蕾，张晓春，张源，等 . 老年卵圆孔未闭患者经导管封堵效果的单中心分析［J］. 复旦学报（医学版）， 2022 ， 49 （ 3 ）： 376 - 383 .

ZHANG L ， ZHANG X C ， ZHANG Y ， et al . Single-center efficacy analysis of transcatheter closure for elderly patients with patent foramen ovale ［J］. Fudan Univ J Med Sci ， 2022 ， 49 （ 3 ）： 376 - 383 .

JURCZYK D ， MACHEREY-MEYER S ， RAWISH E ， et al . New-onset atrial fibrillation after percutaneous patent foramen ovale closure： a meta-analysis ［J］. Clin Res Cardiol ， 2023 ， 112 （ 12 ）： 1824 - 1834 . DOI： 10.1007/s00392-023-02263-8 http://dx.doi.org/10.1007/s00392-023-02263-8 .

SKIBSTED C V ， KORSHOLM K ， PEDERSEN L ， et al . Long-term risk of atrial fibrillation or flutter after transcatheter patent foramen ovale closure： a nationwide Danish study ［J］. Eur Heart J ， 2023 ， 44 （ 36 ）： 3469 - 3477 . DOI： 10.1093/eurheartj/ehad305 http://dx.doi.org/10.1093/eurheartj/ehad305 .

ROHATGI N ， SMILOWITZ N R ， LANSBERG M G . Perioperative stroke risk reduction in patients with patent foramen ovale ［J］. JAMA Neurol ， 2020 ， 77 （ 12 ）： 1479 - 1480 . DOI： 10.1001/jamaneurol.2020.2619 http://dx.doi.org/10.1001/jamaneurol.2020.2619 .

ANDERSEN A ， MATZEN K L ， ANDERSEN G ， et al . Atrial fibrillation after closure of patent foramen ovale in the REDUCE clinical study ［J］. Catheter Cardiovasc Interv ， 2022 ， 99 （ 5 ）： 1551 - 1557 . DOI： 10.1002/ccd.30019 http://dx.doi.org/10.1002/ccd.30019 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke

Solitaire AB stent thrombectomy combined with bridging therapy for special cerebral infarction

Clinical values of transthoracic echocardiography combined with right heart contrast echocardiography in the right-to-left shunt of patent foramen ovale

Ultrasonic measurement of vasodilation in cerebral infarction patients

Diagnostic value of susceptibility weighted imaging in cerebral infarction: report of 38 cases

Related Author

CHEN Guisheng

HOU Liwei

SUN Yangyang

LI Haiyang

KANG Xue

Li Xin

Jin Ge

Zhang Yu

Related Institution

Department of Neurology, Xianyang Central Hospital

Graduate School, 3Department of Neurology of General Hospital, 4Craniocerebral Laboratory, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region

Department of Neurology, Department of Interventional Radiology, Fifth People’s Hospital of Chongqing

Department of Ultrasonography, Department of Cardiology, Chongqing Institute of Interventional Cardiology, Southwest Hospital, Third Military Medical University

Department of Neurology, Department of Ultrasound, Southwest Hospital, Third Military Medical University

⁰