Patent Foramen Ovale (PFO) and Association with Cryptogenic Stroke in Young Patients

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7± in migraine with aura (MA) patients, 33.7± in migraine without aura (MoA) patients, 33.8± in young stroke patients and 20.5± in elderly stroke patients ( P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1± and 25± ( P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.

Download Full-text

The research of the relationships between patent foramen ovale and ischemic stroke in elderly patients

10.21203/rs.3.rs-23628/v1 ◽

2020 ◽

Author(s):

Xu Chao Sun ◽

Wenjing Jiang ◽

Yan Zhao ◽

Lin Ma ◽

Yan Lin ◽

...

Keyword(s):

Ischemic Stroke ◽

Elderly Patients ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Young Patients ◽

Test Group ◽

Control Group ◽

Foramen Ovale ◽

Stroke Patients ◽

Shunt Volume

Abstract Background Research indicates that abnormal embolism caused by patent foramen ovale (PFO) may play an important role in cryptogenic stroke (CS). However, most researches has focused on young patients, and whether abnormal embolism caused by PFO also plays an important role in elderly CS is uncertain. The purpose of this study is to analyze the clinical characteristics of elderly patients with PFO, and to explore the correlation between elderly PFO and ischemic stroke.Methods 62 elderly patients diagnosed with ischemic stroke admitted to Qilu Hospital of Shandong University from April 2014 to April 2019 were selected as the Test Group. 62 non-stroke patients in our hospital's physical examination center and outpatient clinic were selected as the Control Group. Collect clinical data of patients for retrospective analysis.Results The incidence of PFO in the Test Group was significantly higher than that in the Control Group, the difference was statistically significant (p < 0.05). The proportion of large and medium shunt patients in the Test Group was significantly higher than that in the Control Group (p < 0.05). The proportion of patients with migraine in the PFO (+) group in the Test Group was significantly higher than the stroke patients in the PFO (-) group (p < 0.05).Conclusions The shunt volume of the PFO is related to ischemic stroke and may be a risk factor for ischemic stroke.

Download Full-text

Endovascular closure of patent foramen ovale: a critical appraisal of published trials

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190120 ◽

2019 ◽

Vol 77 (10) ◽

pp. 731-740

Author(s):

Charles ANDRÉ

Keyword(s):

Patent Foramen Ovale ◽

Therapeutic Option ◽

Cryptogenic Stroke ◽

Young Patients ◽

Foramen Ovale ◽

Open Label ◽

Number Of Patients ◽

Numbers Needed To Treat ◽

Atrial Septum Aneurysm ◽

Incomplete Occlusion

ABSTRACT The treatment of cryptogenic stroke patients with a patent foramen ovale (PFO) is controversial. A critical review of these studies is presented. Methods A description of all trials comparing medical and endovascular treatment with closing devices is given. Additional pertinent studies are discussed to help construct a rational basis for treatment decisions. Results Initial negative trials evaluating PFO closure were followed by positive studies published in 2017 and 2018. All trials evaluated young patients (up to 60 years). Methodological problems are present in all trials including their open label construction. Most positive trials developed strategies to increase the percentage of patients with interatrial septal aneurysms or hypermobility and large right-to-left shunts. Even in these positive trials, large numbers of patients need to be treated to avoid one stroke. Atrial fibrillation occurred in 2-6% and other adverse effects related to the procedure and to the devices occurred in a substantial number of patients. Incomplete occlusion of the PFO is also frequent. Anticoagulant treatment has not been adequately studied as a therapeutic option. Conclusion Young patients with cryptogenic strokes seem to benefit from endovascular closure of a PFO in the presence of a large right-to-left shunt or an associated atrial septum aneurysm. For most other patients, a highly-individualized decision must be made, taking into account the low risk of recurrence in patients with a cryptogenic stroke attributable to a PFO, the high numbers needed to treat and the risks related to the procedure.

Download Full-text

Left Atrial Function in Young Patients With Cryptogenic Stroke and Patent Foramen Ovale: A Left Atrial Longitudinal Strain Study

Frontiers in Neurology ◽

10.3389/fneur.2020.536612 ◽

2020 ◽

Vol 11 ◽

Author(s):

Julie Gazagnes ◽

Cédric Gollion ◽

Pauline Fournier ◽

Eve Cariou ◽

Vincent Larrue ◽

...

Keyword(s):

Left Atrial ◽

Patent Foramen Ovale ◽

Longitudinal Strain ◽

Cryptogenic Stroke ◽

Young Patients ◽

Atrial Function ◽

Left Atrial Function ◽

Foramen Ovale

Download Full-text

A model of multi-disciplinary approach to the diagnosis and treatment of young patients with cryptogenic stroke and patent foramen ovale

Cardiology in the Young ◽

10.1017/s1047951112000029 ◽

2012 ◽

Vol 22 (3) ◽

pp. 327-334 ◽

Cited By ~ 8

Author(s):

Sara Mazzucco ◽

Paolo Bovi ◽

Monica Carletti ◽

Giampaolo Tomelleri ◽

Giorgio Golia ◽

...

Keyword(s):

Clinical Practice ◽

Medical Therapy ◽

Patent Foramen Ovale ◽

Recurrent Events ◽

Scientific Evidence ◽

Cryptogenic Stroke ◽

Young Patients ◽

Foramen Ovale ◽

Stroke Patients ◽

Therapeutic Decisions

AbstractBackgroundTreatment of patent foramen ovale in young patients with stroke is not supported by robust scientific evidence. In clinical practice, a pragmatic approach is needed to guide such therapeutic decisions. This study aims at standardising the diagnostic pathway for stroke patients younger than 55 years of age with a patent foramen ovale; elaborating a therapeutic algorithm; discussing every case in regular interdisciplinary counselling meeting; and setting up a follow-up schedule to assess clinical outcomes.MethodsThis is a cohort study on the effect of a standardised treatment of stroke patients with a patent foramen ovale. The primary endpoints include occurrence of recurrent ischaemic events, major bleeding, and device-related complications. The secondary endpoints include drug- or procedure-related side effects, persistence of right-to-left shunt, and persistent cardiac arrhythmia of new onset.ResultsA total of 103 patients have been enrolled. In all, 51 patients underwent percutaneous atrial septal repair; of these, one had minor post-procedural bleeding. At 12 months, 25% of this group of patients showed a latent I grade shunt, one patient a latent II degree shunt, and none had a persistent shunt. The remaining 52 patients were addressed to medical therapy; one of them experienced stroke recurrences while on medical therapy.ConclusionsThis model of implementation of available evidence to clinical practice via a group-based, multi-disciplinary counselling provides a shared and coherent decision pathway and yielded a very low rate of recurrent events and therapy-related complications. This approach could be replicated in specific protocols for other complex or neglected clinical problems.

Download Full-text

Comparison of Transthoracic Echocardiography, Transesophageal Echocardiography, and Transcranial Doppler in the Detection of Patent Foramen Ovale as the Etiology for Cryptogenic Stroke

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479318816983 ◽

2018 ◽

Vol 35 (2) ◽

pp. 127-133

Author(s):

Madison B. Stafford ◽

Jennifer E. Bagley ◽

Dora DiGiacinto

Keyword(s):

Transesophageal Echocardiography ◽

Transcranial Doppler ◽

Transthoracic Echocardiography ◽

Gold Standard ◽

Patent Foramen Ovale ◽

Doppler Sonography ◽

Cryptogenic Stroke ◽

Transcranial Doppler Sonography ◽

Young Patients ◽

Foramen Ovale

The correlation between cryptogenic stroke and patent foramen ovale is high in young patients. Currently, transesophageal echocardiography is the gold standard for detection. However, it is invasive and limits Valsalva maneuvers. This article reviews the diagnostic accuracy of the three modalities: transthoracic echocardiography, transesophageal echocardiography, and transcranial Doppler. The results suggest that transcranial Doppler sonography is an accurate, easily accessible procedure for detecting patent foramen ovale and should be considered an excellent alternative to transthoracic or transesophageal echocardiography. Transesophageal echocardiography is still necessary for patients who require treatment. The combination of transcranial Doppler and transesophageal echocardiography provides the highest level of information regarding the complete diagnosis of patent foramen ovales.

Download Full-text

Hole in My Heart

10.1093/med/9780190495541.003.0015 ◽

2016 ◽

Author(s):

Ji Y. Chong ◽

Michael P. Lerario

Keyword(s):

Antiplatelet Therapy ◽

Medical Therapy ◽

Stroke Prevention ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Young Patients ◽

Foramen Ovale ◽

Pfo Closure

The presence of a patent foramen ovale (PFO) is associated with cryptogenic stroke, especially in young patients. Medical therapy for patients with stroke and PFO includes antiplatelet therapy or anticoagulation. PFO closure is not routinely recommended for stroke prevention.

Download Full-text

P918 Screening protocol of patent foramen ovale in cryptogenic stroke

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.554 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

R Menezes Fernandes ◽

T Mota ◽

J Bispo ◽

P Azevedo ◽

J Guedes ◽

...

Keyword(s):

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Young Patients ◽

Significant Risk ◽

Percutaneous Closure ◽

Diagnostic Methods ◽

Foramen Ovale ◽

Transesophageal Echocardiogram ◽

Exclusion Criteria ◽

Screening Protocol

Abstract Introduction Cryptogenic stroke reaches a prevalence of 30% and entails a significant risk of recurrence. Transesophageal echocardiography is the gold standard in identifying potential proximal embolic sources, including patent foramen ovale (PFO). Based on recent evidence, PFO percutaneous closure is recommended in selected cases of cryptogenic stroke, especially if associated with high risk features. Since PFO is present in up to 27% of the general population, the real challenge is to define which patients have a pathogenic PFO. Purpose To develop a pathogenic PFO screening protocol in patients with cryptogenic stroke, aimed at secondary prevention. Methods We revised the literature, analysing published articles in PubMed in the last 5 years, with the keywords "patent foramen ovale and cryptogenic stroke". Subsequently, we produced a screening algorithm based on cryptogenic stroke definition, on RoPE (Risk of Paradoxical Embolism) Score and on the inclusion and exclusion criteria of the CLOSE, REDUCE and RESPECT studies, which showed promising results of PFO closure in this context. Results Our protocol establishes that patients who present with ischemic stroke should be evaluated for risk factors and undergo a detailed etiological study. When the study is inconclusive, the RoPE score is applied to determine the probability of finding a pathogenic or an incidental PFO. If equal or greater than 7 points, in the absence of predefined exclusion criteria, a transesophageal echocardiogram is performed. If the screening is positive, the patient will be referred to the Cardiology Department for therapeutic guidance. If negative, alternative complementary diagnostic methods may be considered. Conclusion Through the application of this protocol, patients with high probability of having a pathogenic PFO and, consequently, those who may benefit from percutaneous closure, will be selected to undergo a screening transesophageal echocardiogram. The implementation of a PFO screening protocol in patients who present with cryptogenic stroke is relevant, by proposing to reduce its recurrence rate through the early referral of young patients with indication for an invasive strategy.

Download Full-text