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

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.

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Abstract 2922: Patent Foramen Ovale Is A Cause Of Ischemic Stroke In Patients With Antiphospholipid Syndrome

Stroke ◽

10.1161/str.43.suppl_1.a2922 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Yoshiaki Shimada

Keyword(s):

Ischemic Stroke ◽

Antiphospholipid Syndrome ◽

Patent Foramen Ovale ◽

Multiple Logistic Regression Analysis ◽

Cryptogenic Stroke ◽

Control Group ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Stroke Patients ◽

Significant Difference

Background: The antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of arterial and/or venous thrombosis and recurrent fetal loss, and can be an independent risk factor for a first-ever ischemic stroke especially in young female patients. Patent foramen ovale (PFO) has been established as a cause of cryptogenic stroke. Atrial septal aneurysm (ASA) is associated with PFO. Until recently, the precise pathophysiology of APS as causing ischemic stroke has been essentially unknown. In the present study, we investigated the relationship between APS and potential embolic sources including PFO and ASA using transesophageal echocardiography (TEE). Methods: This study was a retrospective case series design. From July 2006 to June 2008, 120 patients with ischemic stroke who admitted to Juntendo University Hospital underwent TEE. In this study period, consecutive ischemic stoke patients diagnosed as APS based on the modified Sapporo criteria were enrolled and classified into APS group. Controls were selected among age- and gender-matched stroke patients without APS who also underwent TEE. We assessed clinical characteristics and presence of embolic sources including PFO and atrial septal aneurysm (ASA) between APS and Control groups. Results: Nine of ischemic stroke patients with APS and 41 controls were included. Primary APS was present in one patient (11.1%) of the APS group, and APS with SLE were found in eight patients (88.9%). There is no significant difference in age, risk factors for ischemic stroke, and MRI findings between two groups. The prevalence of PFO and ASA were significantly higher in APS group compared to Control group (89% vs 41%, P=0.027; 67% vs 20%, P=0.015, respectively). C reactive protein was relatively higher in APS group. Multiple logistic regression analysis showed that PFO (OR: 13.71; 95% CI: 1.01 to 185.62; P=0.049) and ASA (OR: 8.06; 95% CI: 1.17 to 55.59; P=0.034) were independently associated with the APS group. Conclusion: Atrial septal abnormalities including PFO and ASA are strongly associated with APS group, and could be potential embolic sources in ischemic stroke patients with APS.

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Prevalence of Patent Foramen Ovale in Migraine Patients with and Without Aura Compared with Stroke Patients. A Transcranial Doppler Study

Cephalalgia ◽

10.1111/j.1468-2982.2006.01156.x ◽

2006 ◽

Vol 26 (8) ◽

pp. 934-939 ◽

Cited By ~ 54

Author(s):

FJ Carod-Artal ◽

L da Silveira Ribeiro ◽

H Braga ◽

W Kummer ◽

HM Mesquita ◽

...

Keyword(s):

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Transcranial Doppler Sonography ◽

Young Patients ◽

Data Bank ◽

Foramen Ovale ◽

Stroke Patients ◽

Doppler Study ◽

The Difference

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.

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Abstract 170: Role of Patent Foramen Ovale in First and Recurrent Childhood Cryptogenic Arterial Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.170 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Evelyn K Shih ◽

Shobha Natarajan ◽

Christine Falkensammer ◽

Lauren A Beslow ◽

Steven R Messe ◽

...

Keyword(s):

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Stroke Recurrence ◽

Atrial Septal Aneurysm ◽

Control Analysis ◽

Foramen Ovale ◽

Arterial Ischemic Stroke ◽

Stroke Patients ◽

Retrospective Case

Background: Numerous studies in adults have reported a robust association between patent foramen ovale (PFO) and cryptogenic arterial ischemic stroke (AIS), particularly in younger adults. The association between PFO and stroke in children has not been well characterized and the clinical significance of identifying a PFO in a child with first or recurrent cryptogenic stroke is currently unknown. Methods: We performed a retrospective case control analysis of a 10-year prospectively enrolled cohort of children with acute AIS who underwent transthoracic echocardiogram (TTE) as part of their diagnostic evaluation. We compared PFO prevalence in children with cryptogenic stroke to those with known stroke etiologies and to non-stroke controls. We also assessed stroke recurrence risk in children with vs without PFO and assessed PFO features that may confer higher stroke risk. Results: Of 119 children with first-ever AIS, 59 had TTE available for central review, of which 17 were cryptogenic and 42 had a known cause. PFO prevalence was higher in the cryptogenic stroke group (X, 24%) compared to both the known stroke etiology group (Y, 6%, p = 0.05) and non-stroke controls (Z, 8%, p = 0.05). However, 2 year recurrence free survival rates in stroke patients with PFO did not differ from those without PFO (HR 1.58, 95% CI 0.18-13.62, p = 0.68). PFOs in children with AIS vs controls had numerically more right-to-left shunt at rest (7 vs 0) and atrial septal aneurysm (4 vs 0) but the study was underpowered to look at these factors. Conclusions: In our prospectively enrolled cohort of children with AIS, we found the prevalence of PFO to be higher in children with cryptogenic stroke compared to healthy controls and non-cryptogenic stroke patients. The implication of PFO for risk of recurrence and optimal secondary preventative treatment remains uncertain and require further study.

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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.

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Presence of Atrial Fibrillation in Stroke Patients With Patent Foramen Ovale: Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.613758 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jessie Ze-Jun Chen ◽

Vincent N. Thijs

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Confidence Interval ◽

Lower Risk ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Stroke Patients ◽

Loop Recorder ◽

Cross Sectional

Purpose: Patent foramen ovale (PFO) is associated with ischemic stroke, especially in patients with embolic stroke of undetermined source. This study aims to evaluate the presence of atrial fibrillation (AF) in ischemic stroke patients with PFO.Methods: We systematically searched EMBASE and MEDLINE databases on May 21, 2020 for studies that analyzed the presence of AF in patients with PFO. The primary outcome was the presence of AF in patients with PFO compared with those without. Outcomes were pooled using a random-effects model using the method of DerSimonian and Laird. We recorded demographic characteristics and the methods used for AF detection in the studies included (unspecified, history/medical records review, ECG, Holter monitor, or loop recorder).Results: A total of 14 studies and 13,245 patients fulfilled the entry criteria. The average age was 61.2 years and 41.3% of the participants were female. There was a lower risk of AF in patients with PFO compared with those without (RR 0.52, 95% confidence interval, 0.41–0.63, p < 0.001). There was no evidence of heterogeneity. The lower risk of AF was found in cross-sectional and longitudinal studies and in studies stratified by average age (<60 or ≥60) and in cryptogenic stroke. Meta-regression by PFO detection technique suggested that studies using transoesophageal echocardiogram for PFO detection reported higher risk of AF (1.39, 95% confidence interval 1.14–1.70, p = 0.004).Conclusion: The presence of a PFO in patients with ischemic stroke/TIA may be associated with a lower risk of AF. Few studies have estimated the risk of future AF in patients with PFO.

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Safety and efficacy of endovascular patent foramen ovale closure: the first results of a Russian multicenter study

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2020-6-26-32 ◽

2020 ◽

Vol 12 (6) ◽

pp. 26-32

Author(s):

D. V. Ognerubov ◽

A. S. Tereshchenko ◽

A. N. Samko ◽

G. К. Arutyunyan ◽

O. A. Sivakova ◽

...

Keyword(s):

Ischemic Stroke ◽

Secondary Prevention ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Young Patients ◽

Paradoxical Embolism ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

History Of ◽

Pfo Closure

Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism.

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Abstract P702: How Many Cryptogenic Stroke Patients Should Be Candidates for Patent Foramen Ovale Closure?

Stroke ◽

10.1161/str.52.suppl_1.p702 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Hidetaka Mitsumura ◽

Tomomichi Kitagawa ◽

Maki Tanabe ◽

Takeo Sato ◽

Hiroki Takatsu ◽

...

Keyword(s):

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Stroke Recurrence ◽

Atrial Septal Aneurysm ◽

Large Artery ◽

Foramen Ovale ◽

Stroke Patients ◽

Ischemic Lesion ◽

Pfo Closure

Background and Purpose: Recent several studies demonstrated that percutaneous patent foramen ovale (PFO) closure reduced the risk of stroke recurrence for patients with cryptogenic stroke (CS) and PFO. Our aim of this retrospective study is to survey the frequency of CS, which can be an indication of PFO closure. Methods: Subjects were consecutive stroke patients with symptomatic ischemic lesion detected by magnetic resonance imaging. Of them, CS were extracted according to exclusion of small-vessel collusion, large-artery atherosclerosis, cardioembolism, definite case of aortogenic embolism, and distinctive causeof ischemic stroke such as arterial dissection, hypercoagulable state and so on. After that, we selected patients in accordance with clinical guideline of PFO closure recommended by the Japanese Stroke Association (Figure). We analyzed the prevalence of CS with right-to-left shunt (RLS) as a good and recommended candidates for PFO closure. Results: Among 1,374 ischemic stroke patients from October 2012 to September 2019 , CS were 240 patients (83 females, mean age of 66 years, 17% of subjects). Of them, 100 patients (42%) had RLS (PFO; 65, atrial septal defect; 1, pulmonary arteriovenous fistula; 1, positive on transcranial Doppler (not performed in TEE) including 21 cases of definite of paradoxical embolism. In 65 patients of CS with PFO, 30 patients younger than 60 years (13% of CS) were good candidates for PFO closure. Moreover, 22 of 1,374 (1.6%) patients who were recommended candidates had one or more high risk factors of PFO, for example large shunt, atrial septal aneurysm, and the presence of shunt at rest (Figure). Conclusions: In our preliminary survey, 2% of acute ischemic stroke should be PFO closure candidates.

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Migraine and hypercoagulable states in ischemic stroke

Cephalalgia ◽

10.1177/0333102411427599 ◽

2011 ◽

Vol 31 (16) ◽

pp. 1609-1617 ◽

Cited By ~ 23

Author(s):

P Martínez-Sánchez ◽

M Martínez-Martínez ◽

B Fuentes ◽

MV Cuesta ◽

L Cuéllar-Gamboa ◽

...

Keyword(s):

Multivariate Analysis ◽

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Brain Infarction ◽

Young Patients ◽

Foramen Ovale ◽

Stroke Patients ◽

Increased Risk ◽

Migraine Group ◽

A Prospective Study

Background: Whether migraine is associated with a higher prevalence of hypercoagulable states (HS) in ischemic stroke patients is unknown. Methods: This was a prospective study of patients under 55 years of age with brain ischemia. A systematic questionnaire addressed the antecedent of migraine with aura (MA) or without aura (MO). We investigated the presence of HS by an extensive battery of haematological tests. The presence of patent foramen ovale (PFO) was assessed by trans-oesophageal echocardiography. Results: A total of 154 patients (95 men; mean ± SD age, 44.12 ± 8.4 years) were included; 44 had migraine, 15 had MA. HS were more frequent in the migraine than non-migraine group (38.6% vs. 16.4%, p < 0.01). The multivariate analysis showed that MO was associated with a 2.88-fold (95% CI, 1.14 to 7.28) increased risk of HS diagnosis. However, in the group of patients with brain infarction under 50 years old, MA, but not MO, was independently associated with HS (OR 6.81; 95% CI, 1.01 to 45.79). Conclusion: In young patients with ischemic stroke, migraine may be associated with a higher frequency of HS.

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Gene polymorphism of methylentetrahydrofolate reductase C 677T in ischemic stroke at young age

Medical alphabet ◽

10.33667/2078-5631-2020-11-46-47 ◽

2020 ◽

Vol 1 (11) ◽

pp. 46-47

Author(s):

O. V. Tsyganenko ◽

L. I. Volkova ◽

A. M. Alasheev

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Gene Polymorphism ◽

Genetic Disorders ◽

Cryptogenic Stroke ◽

Young Patients ◽

Control Group ◽

Stroke Patients ◽

Methylentetrahydrofolate Reductase ◽

Independent Risk Factors

Number of young people with ischemic stroke increases at the present. One of independent risk factors of stroke is hyperhomocysteinemia, wich can be caused by genetic disorders. Objective: to analyze frequency of gene polymorphism of methylentetrahydrofolate reductase C 677T and level of homocysteine among patients with stroke and people without one. Materials and methods. Data of 141 young patients with ischemic stroke, including 30 people with atherothrombotic stroke, 35 with cardioembolic, 36 with lacunar and 40 ones with cryptogenic stroke were analyzed. The control group included 40 young patients without stroke. Results. The frequency of polymorphism MTHFR C 677T (OR = 6,7; 95 % CI: 1,20–37,45: р = 0,027), allel T (OR = 2,29; 95 % CI: 1,10–4,74; р = 0,028) and the level of homocysteine are higher among stroke patients.

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