scholarly journals Short-term results of percutaneous closure of patent foramen ovale guided by transoesophageal echocardiography in patients with cryptogenic stroke: A retrospective study

2021 ◽  
Author(s):  
Yilong Guo ◽  
Zhensu Shi ◽  
Yin Zheng ◽  
Caichan Xie ◽  
Jiao Yi ◽  
...  
Keyword(s):  
Large Volume ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Length Of Hospital Stay ◽  
Transoesophageal Echocardiography ◽  
Interventional Therapy ◽  
Stroke Recurrence ◽  
Short Term ◽  
Amplatzer Occluder ◽  
Group A

Background: This study aimed to assess the short-term (12 months) results of PFO occlusion guided by transoesophageal echocardiography (TEE) and the results of regular transthoracic ultrasound foaming test (UFT). Methods: Data of 75 patients who underwent interventional therapy for PFO and CS were retrospectively analysed. The patients were grouped according to their preoperative UFT results: group A, small volume of right-to-left shunts; group B, moderate volume of right-to-left shunts; and group C, large volume of right-to-left shunts. All patients were treated with an Amplatzer occluder under TEE guidance. UFT follow-up was conducted regularly until 12 months after surgery. Results: No remarkable differences in preoperative data, length of hospital stay, or operative time were noted between the groups. Length of the PFO and diameter of the occluder differed between the groups: group A=group Bp<0.001). One patient in group C developed recurrent stroke 11 months postoperatively. Two patients in group C developed atrial arrhythmia, which improved after 3 months of antiarrhythmic treatment. However, 19 patients still had positive UFT results 12 months postoperatively. Furthermore, the positive UFT rate 12 months postoperatively differed between the groups: group A=group Bp<0.05). Conclusions: In patients with PFO and CS, interventional therapy guided by TEE could lead to satisfactory short-term (12 months) outcomes. A longer PFO and preoperative large-volume shunt were negatively associated with a negative UFT rate 12 months postoperatively. Further studies are required to clarify the relationship between positive UFT results postoperatively and stroke recurrence.

scholarly journals Short-Term Results of Percutaneous Closure of Patent Foramen Ovale Guided by Transoesophageal Echocardiography in Patients with Cryptogenic Stroke: A Retrospective Study

2021 ◽  
Author(s):  
Yilong Guo ◽  
Zhensu Shi ◽  
Yin Zheng ◽  
Xiaoqi Wang ◽  
Zelun Chen ◽  
...  
Keyword(s):  
Large Volume ◽  
Cryptogenic Stroke ◽  
Transoesophageal Echocardiography ◽  
Interventional Therapy ◽  
Stroke Recurrence ◽  
Foramen Ovale ◽  
Short Term ◽  
Group A ◽  
Group B

Abstract Background Patent foramen ovale (PFO) is a risk factor for cryptogenic stroke (CS), and interventional therapy for PFO can reduce the recurrence rate of CS. However, interventional therapies are primarily guided by X-ray imaging, and regular postsurgical follow-up with transthoracic ultrasound foaming test (UFT) is rarely performed. Thus, this study aimed to assess the short-term (1 year) results of PFO occlusion guided by transoesophageal echocardiography (TEE) and the results of regular UFTs. Methods Clinical records, echocardiographic data, and UFT results of 27 patients who underwent interventional therapy for PFO and CS were retrospectively analysed. The patients were grouped according to their preoperative UFT results: group A (n = 4), small volume of right-to-left shunts; group B (n = 8), moderate volume of right-to-left shunts; and group C (n = 15), large volume of right-to-left shunts. All patients were treated using an Amplatzer occluder under TEE guidance. UFT follow-up was conducted regularly until 1 year post-surgery. Results No significant differences in preoperative clinical data, echocardiographic data, or operative time were noted between the groups (P > 0.05). The length of the PFO and the diameter of the occluder differed between the groups as follows: group A = group B < group C (p < 0.05). One year postoperatively, there was no stroke recurrence. Two patients in group C developed atrial arrhythmia, which improved after 3 months of antiarrhythmic treatment. The positive UFT rate gradually decreased postoperatively, and 50% of patients still had a positive UFT 11.75 months after surgery. The positive UFT rate 1 year postoperatively differed between the groups as follows: group A = group B < group C (p = 0.010). A preoperative large-volume shunt was negatively associated with a negative UFT rate 1 year postoperatively (b=-2.118, RR = 0.120, p = 0.002). Conclusion In patients with PFO and CS, interventional therapy guided by TEE led to excellent short-term (1 year) outcomes. The positive UFT rate gradually decreased within 1 year of surgery. Preoperatively, a large volume of right-to-left shunts and large occluders were two risk factors for positive UFT results after surgery. Further studies are required to clarify the relationship between positive UTF results postoperatively and stroke recurrence.

scholarly journals Short-Term Results of Percutaneous Closure of Patent Foramen Ovale Guided By Transoesophageal Echocardiography In Patients With Cryptogenic Stroke: A Retrospective Study

2021 ◽  
Author(s):  
Yilong Guo ◽  
Zhensu Shi ◽  
Yin Zheng ◽  
Caichan Xie ◽  
Jiao Yi ◽  
...  
Keyword(s):  
Large Volume ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Transoesophageal Echocardiography ◽  
Interventional Therapy ◽  
Foramen Ovale ◽  
Short Term ◽  
Group A ◽  
Group B

Abstract Background: Patent foramen ovale (PFO) is a risk factor for cryptogenic stroke (CS), and interventional therapy for PFO can reduce the recurrence rate of CS. However, interventional therapies are primarily guided by X-ray imaging, and data on regular postsurgical follow-up with the transthoracic ultrasound foaming test (UFT) is rare. Thus, this study aimed to assess the short-term (12 months) results of PFO occlusion guided by transoesophageal echocardiography (TEE) and the results of regular UFTs.Methods: Clinical records, echocardiographic data, and UFT results of 75 patients who underwent interventional therapy for PFO and CS were retrospectively analysed. The patients were grouped according to their preoperative UFT results: group A (n=21), small volume of right-to-left shunts; group B (n=22), moderate volume of right-to-left shunts; and group C (n=32), large volume of right-to-left shunts. All patients were treated with an Amplatzer occluder under TEE guidance. UFT follow-up was conducted regularly until 12 months after surgery.Results: No significant differences in preoperative data, length of hospital stay, or operative time were noted between the groups (p>0.05). The length of the PFO and diameter of the occluder differed between the groups as follows: group A=group B<group C (p<0.001). One patient in group C developed recurrent stroke 11 months postoperatively. Two patients in group C developed atrial arrhythmia, which improved after 3 months of antiarrhythmic treatment. However, 19 patients still had positive UFT results 12 months postoperatively. Furthermore, the positive UFT rate 12 months postoperatively differed between the groups as follows: group A=group B<group C (p<0.05). A preoperative large-volume shunt was negatively associated with a negative UFT rate 12 months postoperatively (RR=0.255, p=0.003).Conclusions: In patients with PFO and CS, interventional therapy guided by TEE could lead to satisfactory short-term (12 months) outcomes. Although the positive UFT rate in our study gradually decreased, some patients still had positive UFT results 12 months postoperatively. Preoperatively, a large volume of right-to-left shunts and a longer PFO were two risk factors for positive UFT results postoperatively. Further studies are required to clarify the relationship between positive UFT results postoperatively and stroke recurrence.

Abstract W MP65: Moderate to Severe Left Atrial Enlargement is Associated with Cardioembolic or Cryptogenic Stroke Recurrence in a Multiethnic Cohort: The Northern Manhattan Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Yeseon P Moon ◽  
Consuelo Mora-McLaughlin ◽  
Joshua Z Willey ◽  
Marco R Di Tullio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Cardioembolic Stroke ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Subtypes ◽  
Multiethnic Cohort

Background: While left atrial (LA) enlargement increases incident stroke risk, the association with recurrent stroke is unclear. Our aim was to determine the association of LA enlargement (LAE) with stroke recurrence risk and recurrent stroke subtypes likely related to embolism (cryptogenic or cardioembolic). Methods: We enrolled 655 first ischemic stroke patients in the Northern Manhattan Stroke Study. LA size was measured by two-dimensional echocardiogram as part of the clinical evaluation and patients were followed annually for up to 5 years. LA size adjusted for sex and body surface area was categorized into three groups: normal (52.7%), mild LAE (31.6%), and moderate to severe LAE (15.7%). The outcomes were total recurrent stroke, and recurrent combined cryptogenic or cardioembolic stroke. Cox proportional hazard models assessed the association between LA size and risk of stroke recurrence. Results: Of 655 patients, LA size data was present in 529 (81%). Mean age was 69 ± 13 years; 46% were male and 18% had atrial fibrillation. Over a median of 4 years, recurrent stroke occurred in 83 patients (16%), 29 were cardioembolic or cryptogenic stroke. After adjusting for baseline demographics and risk factors including atrial fibrillation and congestive heart failure, compared to normal LA size, moderate to severe LAE was associated with greater risk of recurrent combined cardioembolic or cryptogenic stroke (adjusted HR 2. 99, 95% CI 1. 10 to 8.13), but not with risk of total stroke recurrence (adjusted HR 1.18, 95% CI 0.60 to 2.32). Mild LAE was not associated with either total stroke recurrence or the combined recurrent cryptogenic or cardioembolic stroke subtypes. Conclusion: Moderate to severe LAE is an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Future research is needed to determine if anticoagulant use reduces the risk of recurrence in ischemic stroke patients with moderate to severe LAE.

Abstract 73: Risk of Paradoxical Embolism (RoPE) Score Stratification of Pooled Pfo Closure Clinical Trial Data: Lack of Evidence for Improvement in Patient Selection for Closure

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David E Thaler ◽  
Issa J Dahabreh ◽  
Robin Ruthazer ◽  
Anthony J Furlan ◽  
Mark Reisman ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Recurrent Stroke ◽  
Statistical Significance ◽  
Cryptogenic Stroke ◽  
Recurrence Score ◽  
Paradoxical Embolism ◽  
Stroke Recurrence ◽  
P Value ◽  
Atrial Septal Aneurysm ◽  
Pfo Closure

Introduction: The Risk of Paradoxical Embolism (RoPE) Score can disaggregate patients with cryptogenic stroke (CS) and patent foramen ovale (PFO) into those who are more likely to have a pathogenic PFO (high RoPE score) than an incidental PFO (low RoPE score). Those with higher RoPE scores have a lower risk of recurrent stroke and different recurrence predictors compared to those with low RoPE scores. Hypotheses: Patients with high RoPE scores benefit more from PFO closure than patients with low RoPE scores. Patients with high RoPE scores and risk factors for recurrence should benefit even more. Methods: The RoPE score was created from a database of CS patients with known PFO status to estimate stratum-specific PFO-attributable fraction and recurrence rates. Variables that predict stroke recurrence in high RoPE score groups (atrial septal aneurysm, history of stroke/TIA prior to index event) were added – the “RoPE Recurrence Score.” Using pooled individual patient data from all 3 RCTs of PFO closure vs. medical therapy (ITT populations; stroke outcome) we tested the ability of the scores to predict the heterogeneity of response to assigned treatment. Results: The mean RoPE score was significantly higher (6.8 vs. 6.3) with smaller variance (Stdev 1.5 vs. 1.9) in the pooled RCT population than in the original RoPE cohort (p<0.0001). Hazard ratios favoring closure were 0.82 (0.42-1.59, p=0.56) in the low RoPE score (<7) group and 0.31 (0.11-0.85, p=0.02) in the high RoPE score (≥7) group but the interaction p-value was not significant (p=0.12). The RoPE Recurrence score did not improve the prediction of treatment response (low score HR=0.65 (0.31-1.37), p=0.26; high score HR=0.58 (0.26-1.26), p=0.17; interaction p=0.82). Conclusion: As expected, the HR favoring closure trended lower in the high RoPE score group in the RCTs but missed statistical significance. The RoPE Recurrence score did not improve the prediction. This may be due to the narrow distribution of relatively high RoPE scores amongst RCT patients and so a low power to detect heterogeneity of treatment effect. Given that PFO closure can only prevent PFO-related recurrences, the treatment effect may also have been obscured by including recurrent strokes with non-PFO-related mechanisms.

Abstract 198: PFO and Recurrent Stroke: Predictors Differ In Patients With “Probable Pathogenic” Versus Other PFOs

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
David E Thaler ◽  
Robin Ruthazer ◽  
Emanuele Di Angelantonio ◽  
Marco R Di Tullio ◽  
Jennifer S Donovan ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Recurrence Risk ◽  
Paradoxical Embolism ◽  
Attributable Fraction ◽  
Survival Models ◽  
Stroke Recurrence ◽  
Stroke Risk Factors ◽  
Heterogenous Group ◽  
Echo Features

Background The “RoPE Score” is a predictive model created to stratify patients by the likelihood that a patent foramen ovale (PFO) is incidental or pathogenic using clinical variables. We hypothesized that the predictors of recurrent stroke differ between patients with pathogenic and incidental PFOs. Methods Patients in the Risk of Paradoxical Embolism (RoPE) database with cryptogenic stroke (CS) and PFO were classified as having a probable pathogenic PFO (RoPE Score of >6, estimated PFO attributable fraction 72-99%, n=646) and others (RoPE Score of <6 points estimated PFO attributable fraction 0-72%, n=678). We tested 15 clinical, 5 radiological, and 3 echo variables for associations with stroke recurrence using Cox survival models with component database as a stratification factor. An interaction with RoPE score was checked for the variables that were significant. Results Follow-up was available for 91%, 80%, and 58% at 1, 2, and 3 years. Overall, a higher recurrence risk was associated with an index TIA, not being on a statin at baseline, and having a prior radiological stroke. For the low RoPE score group, older age, male sex, high cholesterol and antiplatelet (vs warfarin) treatment predicted recurrence. For those with high RoPE scores, predictors were prior (clinical) stroke/TIA and 2 echo features: septal hypermobility and a small shunt (<10 bubbles). Conclusions Predictors of recurrence differ when PFO relatedness is classified by the RoPE Score. The hypothesis that patients with CS and PFO form a heterogenous group with different stroke mechanisms is supported. Conventional stroke risk factors were strong predictors among patients with lower RoPE scores. Echocardiographic features - including a counterintuitive association between smaller shunts and increased recurrence risk - were uniquely predictive in the high RoPE score group (likely pathogenic PFO).

Echocardiography

2018 ◽  
Author(s):  
Sahrai Saeed ◽  
Eva Gerdts
Keyword(s):  
Ischaemic Stroke ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Transoesophageal Echocardiography ◽  
Additional Insight ◽  
Wide Range ◽  
Risk Sources ◽  
Ischaemic Attack ◽  
And Function ◽  
Current Guidelines

Current guidelines recommend extensive cardiovascular imaging in patients who experience ischaemic stroke or a transient ischaemic attack to prevent recurrent stroke. High-quality echocardiography is crucial for detection of the wide range of cardiac and proximal aortic conditions that can predispose to cerebral embolism. These conditions may be classified as major, minor, or uncertain risk sources of embolism. Although both transthoracic (TTE) and transoesophageal echocardiography (TOE) have substantial clinical utility in patients with cryptogenic stroke, these methods offer complementary information. TOE is typically used for assessment of defects in the atrial septum or detection of thrombus in the left atrial appendage. In contrast, TTE is the recommended method for assessment of cardiac chamber structure and function, and valvular disease. Furthermore, assessment of aortic stiffness and electrocardiography may offer additional insight to cardiac function. This chapter gives an overview of the use of echocardiography in ischaemic stroke patients.

scholarly journals Short-Term and Two-Year Rate of Recurrent Cerebrovascular Events in Patients with Acute Cerebral Ischemia of Undetermined Aetiology, with and without a Patent Foramen Ovale

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Silvia Di Legge ◽  
Fabrizio Sallustio ◽  
Emiliano De Marchis ◽  
Costanza Rossi ◽  
Giacomo Koch ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Recurrent Events ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Stroke Recurrence ◽  
Foramen Ovale ◽  
Related Factors ◽  
Age Related ◽  
Cerebrovascular Events ◽  
Acute Cerebral Ischemia

Purpose. We investigated stroke recurrence in patients with acute ischemic stroke of undetermined aetiology, with or without a patent foramen ovale (PFO). Methods. Consecutive stroke patients underwent to Transcranial Doppler and Transesophageal Echocardiography for PFO detection. Secondary stroke prevention was based on current guidelines. Results. PFO was detected in 57/129 (44%) patients. The rate of recurrent stroke did not significantly differ between patients with and without a PFO: 0.0% versus 1.4% (1 week), 1.7% versus 2.7% (1 month), and 3.5% versus 4.2% (3 months), respectively. The 2-year rates were 10.4% (5/48) in medically treated PFO and 8.3% (6/72) in PFO-negative patients (), with a relative risk of 1.25. No recurrent events occurred in 9 patients treated with percutaneous closure of PFO. Conclusion. PFO was not associated with increased rate of recurrent stroke. Age-related factors associated with stroke recurrence in cryptogenic stroke should be taken into account when patients older than 55 years are included in PFO studies.

scholarly journals Impact of Infection on the Risk of Recurrent Stroke Among Patients With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2395-2403 ◽  
Author(s):  
Jie Xu ◽  
Gulbahram Yalkun ◽  
Meng Wang ◽  
Anxin Wang ◽  
Runqi Wangqin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Recurrent Stroke ◽  
Medical Data ◽  
Stroke Recurrence ◽  
Short Term ◽  
Cox Models

Background and Purpose: Infection occurs commonly in patients with acute ischemic stroke. We aimed to investigate the association of infection with short- and long-term risk of recurrent stroke in patients with ischemic stroke. Methods: Data were derived from ischemic stroke patients in 2 stroke registries: the CSCA (Chinese Stroke Center Alliance) program recorded medical data during hospitalization, and the CNSR-III (Third China National Stroke Registry) recorded the medical data during hospitalization and finished 1-year follow-up. Associations of infection (pneumonia or urinary tract infection) during hospitalization with recurrent stroke in short (during hospitalization) and long term (since 30 days to 1 year after stroke onset) were analyzed. Short-term outcomes were analyzed with logistic models and long-term outcomes with Cox models. Results: In the CSCA (n=789 596), the incidence of infection during hospitalization reached 9.6%. Patients with infection had a higher risk of stroke recurrence during hospitalization compared with patients without infection (10.4% versus 5.2%; adjusted odds ratio, 1.70 [95% CI, 1.65–1.75]; P <0.0001). In the CNSR-III (n=13 549), the incidence of infection during hospitalization was 6.5%. Infection during hospitalization was significantly associated with short-term risk of recurrent stroke (7.4% versus 3.9%; adjusted odds ratio, 1.40 [95% CI, 1.05–1.86]; P =0.02) but not with long-term risk of recurrent stroke (7.2% versus 5.2%; adjusted hazard ratio, 1.16 [95% CI, 0.88–1.52]; P =0.30). Conclusions: Infection was an independent risk factor for high risk of early stroke recurrence during hospitalization, but we have not found its sustained effect on long-term recurrent risk in patients with acute ischemic stroke.

scholarly journals The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale and methods

2018 ◽  
Vol 14 (2) ◽  
pp. 207-214 ◽  
Author(s):  
Hooman Kamel ◽  
WT Longstreth ◽  
David L Tirschwell ◽  
Richard A Kronmal ◽  
Joseph P Broderick ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intracranial Hemorrhage ◽  
Anticoagulant Therapy ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
P Wave ◽  
Rank Test ◽  
Stroke Recurrence ◽  
Double Blind ◽  
Major Hemorrhage

Rationale Recent data suggest that a thrombogenic atrial substrate can cause stroke in the absence of atrial fibrillation. Such an atrial cardiopathy may explain some proportion of cryptogenic strokes. Aims The aim of the ARCADIA trial is to test the hypothesis that apixaban is superior to aspirin for the prevention of recurrent stroke in subjects with cryptogenic ischemic stroke and atrial cardiopathy. Sample size estimate 1100 participants. Methods and design Biomarker-driven, randomized, double-blind, active-control, phase 3 clinical trial conducted at 120 U.S. centers participating in NIH StrokeNet. Population studied Patients ≥ 45 years of age with embolic stroke of undetermined source and evidence of atrial cardiopathy, defined as ≥ 1 of the following markers: P-wave terminal force >5000 µV × ms in ECG lead V1, serum NT-proBNP > 250 pg/mL, and left atrial diameter index ≥ 3 cm/m2 on echocardiogram. Exclusion criteria include any atrial fibrillation, a definite indication or contraindication to antiplatelet or anticoagulant therapy, or a clinically significant bleeding diathesis. Intervention: Apixaban 5 mg twice daily versus aspirin 81 mg once daily. Analysis: Survival analysis and the log-rank test will be used to compare treatment groups according to the intention-to-treat principle, including participants who require open-label anticoagulation for newly detected atrial fibrillation. Study outcomes The primary efficacy outcome is recurrent stroke of any type. The primary safety outcomes are symptomatic intracranial hemorrhage and major hemorrhage other than intracranial hemorrhage. Discussion ARCADIA is the first trial to test whether anticoagulant therapy reduces stroke recurrence in patients with atrial cardiopathy but no known atrial fibrillation.

A Clinical Study and Management of Inguino-scrotal Swellings In Children

2018 ◽  
Vol 2 (S1) ◽  
pp. e000125
Author(s):  
Khyati Vaja ◽  
Mukesh Suvera
Keyword(s):  
Inguinal Hernia ◽  
Pediatric Surgery ◽  
Pediatric Patients ◽  
Undescended Testis ◽  
Length Of Hospital Stay ◽  
Indirect Inguinal Hernia ◽  
Short Term ◽  
One Year ◽  
Groin Hernias ◽  
Inguinal Hernia In Children

Aims and Objectives: To know the most common surgical problems in pediatric patients presented with inguino-scrotal swellings and management done routinely. Methodology: This study was carried out in the department of general surgery, Sharadaben hospital and pediatric surgery of VS hospital, Ahmedabad. The cases were studied for a period of about one year (January, 2017 to Dec, 2017) and all children below 12 years of age, presenting to us with inguinoscrotal swellings were included in this study. The information was analysed in terms of age, diagnosis, procedure carried out and outcome. Results: Amongst the 150 children under the age of 12 years, 143 patients were males and 7 were females. Among these 150, 52 cases were of hydrocoele, 70 cases of hernia (of which 63 were males and 7 were females), 25 cases of undescended testis and 3 cases of epididymo orchitis were documented. All cases underwent simple herniotomy for hernia and hydrocoele, orchidopexy for undescended testis. The length of hospital stay ranged from 2-4 days with mean of 2.46 days. 11 children in the study were documented to have short term complications, all of which were recognised in the hospital and managed with good results. Conclusion: Hernia and Hydrocoele in children are often congenital and diagnosed clinically (history and examination). Indirect inguinal hernia are more common than other groin hernias. Open herniotomy is the operation of choice for inguinal hernia in children.

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