r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2022-27-2-53-59r-n-j-297Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSОткрытое овальное окно как причина криптогенного ишемического инсультаPatent foramen ovale as a cause of cryptogenic ischemic strokehttps://orcid.org/0000-0001-6824-4114РамазановГ. Р.RamazanovG. R.

Москва

Moscow

ramazanovgr@sklif.mos.ruhttps://orcid.org/0000-0002-8490-1417КовалеваЭ. А.KovalevaE. A.

Ковалева Элла Александровна – канд. мед. наук, ст. преподаватель учебного отдела, врач-невролог неврологического отделения для больных с острыми нарушениями мозгового кровообращения с палатой реанимации и интенсивной терапии

Москва

Moscow

kovalevaea@sklif.mos.ruhttps://orcid.org/0000-0001-8096-5029АхматхановаЛ.Х.-Б.AkhmatkhanovaL.Kh.-B.

Москва

Moscow

akhmatkhanovalb@sklif.mos.ruhttps://orcid.org/0000-0003-3292-8789ПетриковС. С.PetrikovS. S.

Москва

Moscow

petrikovss@sklif.mos.ruНаучно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. МосквыРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health DepartmentRussian Federation2022140520222725359Copyright © Рамазанов Г.Р., Ковалева Э.А., Ахматханова Л., Петриков С.С., 20222022Рамазанов Г.Р., Ковалева Э.А., Ахматханова Л., Петриков С.С.Ramazanov G.R., Kovaleva E.A., Akhmatkhanova L., Petrikov S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/297

Открытое овальное окно (ООО) с анатомо-физиологической точки зрения является нормальным сообщением между предсердиями, которое присутствует внутриутробно и позволяет оксигенированной плацентарной крови достигать артериального кровообращения плода. При неполном послеродовом сращении первичной и вторичной перегородок образуется ООО. В два последних десятилетия клинический интерес к проблеме ООО продиктован тем фактом, что установлена его роль в развитии таких клинических синдромов, как ишемический инсульт (ИИ), инфаркт миокарда, тромбоэмболия легочной артерии, мигрень и декомпрессионная болезнь ныряльщиков, а также внедрением методик эндоваскулярного транскатетерного закрытия дефекта межпредсердной перегородки. Установлено, что частота выявления ООО у пациентов с крипто- генным инсультом (КИ) в среднем в 2 раза выше, чем у больных с установленной причиной ИИ, и колеблется от 40% до 50%.

Цель работы – повышение информированности врачей-неврологов о причинах, патогенетических механизмах развития, методах диагностики и лечения ИИ у пациентов с ООО.

Материал и методы

Материал и методы. Для достижения поставленной цели были проанализированы результаты научных исследований, посвященных ООО как фактору риска КИ. Поиск литературы проводили в электронных поисковых системах Scopus, eLibrary, PubMed по ключевым словам «ишемический инсульт», «криптогенный инсульт», «открытое овальное окно», «патогенез ишемического инсульта». Для анализа были отобраны научные статьи, опубликованные в период с 1878 по 2021 г. 31% проанализированных работ не старше 5 лет.

Заключение

Заключение. ООО этиологически связано с КИ. Возможные механизмы ИИ у пациентов с ООО включают образование тромбов in situ, парадоксальную эмболию, а также предсердные аритмии. Транскатетерное эндоваскулярное закрытие ООО с анатомическими признаками высокого риска цереброваскулярных событий в сочетании с антиагрегантной терапией показаны пациентам с КИ в возрасте от 18 до 60 лет как оптимальное средство вторичной профилактики ишемического инсульта.

A patent foramen ovale from an anatomical and physiological point of view is a normal communication between the atria, which is present in utero and allows oxygenated placental blood to reach the fetal arterial circulation. With incomplete postpartum fusion of the primary and secondary septa, a patent foramen ovale is formed. In the last two decades, clinical interest in the problem of the patent foramen ovale is dictated by the fact that its role in the development of such clinical syndromes as ischemic stroke, myocardial infarction, pulmonary embolism, migraine and decompression sickness of divers has been established, as well as the introduction of endovascular techniques for endovascular transcatheter closure of the atrial septal defect. It was found that the frequency of patent foramen ovale detection in patients with cryptogenic stroke is on average 2 times higher than in patients with an established cause of ischemic stroke and ranges from 40% to 50%.

Aim of study

Aim of study. Raising awareness of neurologists about the causes, pathogenetic mechanisms of development, methods of diagnosis and treatment of ischemic stroke in patients with patent foramen ovale.

Material and methods

Material and methods. To achieve this goal, the results of scientific research devoted to patent foramen ovale as a risk factor for cryptogenic stroke were analyzed. The literature search was carried out in electronic search engines Scopus, eLibrary, PubMed using the keywords: «ischemic stroke», «cryptogenic stroke», «patent foramen ovale», «pathogenesis of ischemic stroke». Scientific articles published between 1878 and 2021 were selected for analysis. 31% of the analyzed works are not older than 5 years.

Conclusion

Conclusion. The patent foramen ovale is etiologically associated with cryptogenic stroke. Possible mechanisms of ischemic stroke in patent foramen ovale patients include in situ thrombosis, paradoxical embolism, and atrial arrhythmias. Transcatheter endovascular closure of patent foramen ovale with anatomical signs of a high risk of cerebrovascular events in combination with antiplatelet therapy are indicated for patients with cryptogenic stroke aged 18 to 60 years as an optimal means of secondary prevention of ischemic stroke.

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The authors declare that there are no conflicts of interest present.