Precision Diagnosis and Risk Stratification Strategies for Patent Foramen Ovale-Related Stroke

doi:10.3969/j.issn.1673-5765.2025.11.008

Abstract

Abstract: Patent foramen ovale (PFO) is one of the most common congenital cardiac anomalies in adults. As an intervenable cause of cryptogenic stroke, ischemic stroke induced by PFO is characterized by a high recurrence rate, severe neurological impairment, and potential risk of multi-organ embolism. Precise identification of PFO-related stroke patients and treatment with transcatheter PFO closure can significantly improve neurological prognosis. PFO can cause stroke through mechanisms such as paradoxical embolism and in-situ thrombosis. Therefore, the management of PFO-related stroke requires integrating information including PFO anatomical and functional characteristics as well as clinical manifestations of stroke. Risk assessment should be performed using the risk of paradoxical embolism score and the PFO-associated stroke causal likelihood classification system, followed by the formulation of reasonable and individualized treatment plans (such as drug treatment, interventional therapy, and surgical treatment) to reduce stroke recurrence risk and enhance patient outcomes. This article reviews the risk assessment, imaging characteristics, and diagnostic strategies for PFO-related stroke, aiming to provide evidence for precise identification and intervention of PFO-related stroke and reducing stroke recurrence.

Key words: Patent foramen ovale; Cryptogenic stroke; Diagnostic process; Risk stratification; Multimodal imaging

摘要： 卵圆孔未闭（patent foramen ovale，PFO）是成人最常见的先天性心脏异常之一。作为一种可干预的隐源性卒中病因，PFO导致的缺血性卒中具有复发率高、神经功能损伤严重的特点，且存在潜在多器官栓塞风险。精准识别PFO相关卒中患者并采取经导管PFO封堵术治疗，可显著改善神经功能预后。PFO可通过反常栓塞、原位血栓形成等机制引起卒中。因此，针对PFO相关卒中的管理需综合PFO的解剖与功能特征、卒中临床表现等信息，借助反常栓塞风险评分系统、PFO相关卒中因果可能性分类系统进行风险评估，并制订合理的个体化治疗方案（如药物、介入及手术等治疗措施），以降低卒中复发风险、改善患者预后。本文综述了PFO相关卒中的风险评估、影像学特征及诊断策略，旨在为临床精准识别及干预PFO相关卒中、降低卒中复发风险提供依据。

关键词: 卵圆孔未闭; 隐源性卒中; 诊断流程; 风险分层; 多模态影像

CLC Number:

LIU Junying, SU Ying, JIANG Hongliang, CAO Liming. Precision Diagnosis and Risk Stratification Strategies for Patent Foramen Ovale-Related Stroke[J]. Chinese Journal of Stroke, 2025, 20(11): 1394-1401.

刘君英, 苏颖, 江红亮, 曹黎明. 卵圆孔未闭相关卒中的精准诊断与风险分层策略[J]. 中国卒中杂志, 2025, 20(11): 1394-1401.

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