Patent Foramen Ovale in Young Patients with Ischemic Stroke

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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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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CLINICAL DIFFERENCES OF CRYPTOGENIC ISCHEMIC STROKE IN YOUNG PATIENTS WITH AND WITHOUT PATENT FORAMEN OVALE

10.26226/morressier.5ab8f563d462b8029238d23a ◽

2018 ◽

Author(s):

Ossi Nerg

Keyword(s):

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Young Patients ◽

Foramen Ovale ◽

Stroke In Young

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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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Patent foramen ovale in a cohort of young patients with cryptogenic ischemic stroke

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2005000300012 ◽

2005 ◽

Vol 63 (2b) ◽

pp. 427-429 ◽

Cited By ~ 3

Author(s):

Marcus Tulius T. Silva ◽

Roíza Rodrigues ◽

João Tress ◽

Rosaura Victer ◽

Francisco Chamiê

Keyword(s):

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Young Patients ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Surgical Closure ◽

Small Series ◽

Percutaneous Device ◽

Ischemic Events

OBJECTIVE: Although its role is a matter of debate, some studies described a higher prevalence of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) in young stroke patients, with higher risk with PFO / ASA association (OR 4.96). The aim of this study was determine the prevalence of PFO and ASA in a cohort of cryptogenic ischemic stroke (IS) patients younger than 55 years and to follow-up after surgical or percutaneous endovascular closure (PEC). METHOD: In 21 months we identified all patients less than 55 years old with IS who were admitted to our hospital. Cryptogenic IS was considered if there is not an identifiably cause to cerebral ischemia. Transesophageal echocardiography (TEE) was performed in all patients. After interatrial septal abnormalities diagnosis, percutaneous device closure was offered to all. Patients were followed monthly and keeped with oral AAS or Clopidogrel. RESULTS: We identified 189 patients with IS and 32 were less than 55 years old (16.9%). In 29 the IS was cryptogenic. TEE was performed in all patients and some form of interatrial septal abnormality was identified in 12 (12/29 - 41.3%); 5 had a PFO and in 7 there was PFO plus ASA. Ten patients were submitted to PEC and 2 were submitted to surgical closure. In mid-term follow-up (28 months) no ischemic events occurred and 2 patients related disappearance of migraine symptoms. CONCLUSION: Our small series description is in accordance with other studies and suggests a possible relation between interatrial septal abnormalities and IS in a cohort of young patient.

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HIGH FREQUENCY OF RECENT ISCHEMIC STROKE IN PATIENTS WITH PULMONARY EMBOLISM AND PATENT FORAMEN OVALE SUGGESTS THAT PARADOXICAL EMBOLISM IS A FREQUENT MECHANISM

10.26226/morressier.58e389b4d462b802923849b4 ◽

2017 ◽

Author(s):

Serge Timsit

Keyword(s):

Pulmonary Embolism ◽

Ischemic Stroke ◽

High Frequency ◽

Patent Foramen Ovale ◽

Paradoxical Embolism ◽

Foramen Ovale

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Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism

Annals of Internal Medicine ◽

10.7326/l19-0478 ◽

2019 ◽

Vol 171 (7) ◽

pp. 527

Author(s):

Preetham Kumar ◽

M. Khalid Mojadidi ◽

Bernhard Meier ◽

Jonathan M. Tobis

Keyword(s):

Pulmonary Embolism ◽

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Foramen Ovale

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Recurrent Patent Foramen Ovale-Related Cerebral Infarcts Alternately Causing Bilateral Hand Paresis

Case Reports in Neurology ◽

10.1159/000479787 ◽

2017 ◽

Vol 9 (2) ◽

pp. 210-215 ◽

Cited By ~ 2

Author(s):

Seung-Jae Lee

Keyword(s):

Ischemic Stroke ◽

Transesophageal Echocardiography ◽

Patent Foramen Ovale ◽

Holter Monitoring ◽

Precentral Gyrus ◽

Foramen Ovale ◽

Rare Presentation ◽

Laboratory Findings ◽

Abnormal Finding ◽

Hand Motor Area

Isolated hand paresis is a rare presentation of stroke, which mostly results from a lesion in the cortical hand motor area, a knob-like area within the precentral gyrus. I report the case of a patient who experienced recurrent ischemic stroke alternately involving bilateral hand knob areas, causing isolated hand paresis. There was no abnormal finding on brain and neck magnetic resonance angiography, transthoracic echocardiography, and 48-h Holter monitoring, and there were no abnormal immunologic and coagulation laboratory findings. The only embolic source was found to be a patent foramen ovale, which was proven on transesophageal echocardiography. The patient underwent percutaneous device closure of patent foramen ovale after alternately repeated paresis of both hands despite antiplatelet treatment. This case suggests that ischemic stroke affecting the cortical knob area, albeit extremely rare, may recur due to a patent foramen ovale, and it necessitates complete investigation, including transesophageal echocardiography, to identify possible embolic sources.

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